Case Manager, Reimbursement

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and coordinate the daily management of an assigned caseload.

• Ensure that case components and tasks are executed promptly, facilitating the necessary progression of cases through the established processes.

• Serve as the main point of contact for communications related to prior authorization and appeal processing.

• Engage with patients, healthcare providers, field reimbursement representatives, and other external partners.

• Convey patient benefits and responsibilities accurately and in a timely manner.

• Evaluate and refer patients to special programs or services as needed.

• Conduct quality checks on cases and report any trends to leadership.

• Address complex cases that involve multiple disease states.

• Collaborate with internal and external parties to ensure a smooth initiation of therapy.

• Report Adverse Drug Events in accordance with pharmaceutical regulations.

• Identify product quality complaints and relay caller or written information to the respective manufacturer.

• Carry out additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or six years of relevant professional experience.

• At least two (2) years of relevant experience in pharmacy benefit management.

• Experience in comprehensive benefits investigation.

• Prior Authorization Program (PAP) experience is desirable.

• Certification is preferred but not mandatory.

• Proficient in Microsoft Office applications.

• Familiarity with medical and claims processing terminology.

• Exceptional written and verbal communication skills, including the ability to provide clear instructions.

• Strong critical thinking abilities.

• Capacity to manage multiple tasks simultaneously.

• Experience with Salesforce is preferred.

• Must adhere to applicable company, state, and federal safety and environmental policies and procedures.

🏝️ Benefits

• Opportunities for remote work.

• Potential for career advancement through promotion.

• 401K plan with company matching.

• Tuition reimbursement available.

• Flexible work environment.

• Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance available.

• Short-term disability insurance.

• Long-term disability insurance.

• Life insurance coverage.

• Employee discount program.