Case Manager, Reimbursement

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

📋 Description

• Oversee daily management and coordination of caseload to ensure timely completion of all case elements and tasks, facilitating the progression of cases as required.

• Serve as the primary contact responsible for communications related to prior authorization and appeal processing for patients, healthcare providers, field reimbursement representatives, and other external stakeholders.

• Deliver timely and accurate information regarding patient benefits and responsibilities.

• Appropriately assess and refer patients to special programs/services as needed.

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

• Ensure adherence to quality and production standards while following all applicable company, state, and federal safety and environmental programs and procedures.

• Resolve complex cases across multiple disease states while collaborating with key internal and external stakeholders to ensure a smooth initiation of therapy.

• Report any Adverse Drug Events experienced by patients in accordance with pharmaceutical regulations.

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

• Willingness to travel as necessary - This is primarily a remote role; however, occasional travel may be necessary based on client, business, or training requirements. While travel is expected to be infrequent, candidates must be prepared to travel as needed. Travel obligations may vary based on client programs and business goals. Other duties may be assigned.

⛳️ Requirements

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

• A minimum of two (2) years of 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.

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

• Strong critical thinking skills along with the capacity to multi-task are essential.

🏝️ Benefits

• Remote opportunities.

• Competitive salaries.

• Opportunities for career advancement.

• 401K plan with company match*

• Tuition assistance available after 90 days of employment.

• Flexible work environment.

• 20 days of Paid Time Off (PTO).

• Paid Holidays.

• Employee assistance programs.

• Medical, Dental, and Vision coverage.

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

• Telemedicine services (Virtual doctor appointments).

• Wellness program.

• Adoption assistance.

• Short-term disability coverage available after 90 days of employment.

• Long-term disability coverage.

• Life insurance.

• Discount programs.