Case Manager – Reimbursement

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

📋 Description

• Oversee and coordinate daily case management for an assigned caseload.

• Ensure timely completion of case elements and tasks, facilitating the progress of cases through the necessary processes.

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

• Accurately and promptly convey patient benefits and responsibilities.

• Evaluate and refer patients for specialized programs and services.

• Conduct quality checks on cases and report trends to management.

• Troubleshoot intricate cases involving various disease states with both internal and external stakeholders.

• Report patient Adverse Drug Events in accordance with pharmaceutical guidelines.

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

• Uphold quality and productivity standards while adhering to safety and environmental protocols.

• Carry out additional duties as assigned.

⛳️ Requirements

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

• Two (2) or more years of pertinent experience in pharmacy benefit management is preferred.

• Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist is preferred.

• 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.

• Must have strong critical thinking abilities and the capability to manage multiple tasks simultaneously.

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

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible work environment.

• 20 days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term and long-term disability coverage.

• Life insurance options.

• Discount programs.