Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate day-to-day case management for the assigned caseload.

• Ensure timely completion of tasks by responsible parties, facilitating the necessary movement of cases through the required processes.

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

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

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients to special programs or services when appropriate.

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

• Comply with quality and production standards, as well as relevant company, state, and federal safety and environmental protocols.

• Address complex cases that involve multiple disease states.

• Collaborate with internal and external stakeholders to ensure an optimal initiation of therapy.

• Report Adverse Drug Events encountered by patients in alignment with pharmaceutical regulations.

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

• Execute additional duties as assigned.

⛳️ Requirements

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

• Preferred: Two (2) or more years of relevant experience in pharmacy benefit management.

• Preferred: Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist.

• 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 deliver clear instructions.

• Strong critical thinking skills and the ability to manage multiple tasks simultaneously are essential.

• Must be available for an 8-hour workday between 8am and 8pm EST.

• Training hours are from 9am to 6pm EST.

🏝️ Benefits

• Opportunities for remote work.

• Potential for career advancement and promotion.

• 401K plan with company matching contributions.

• Tuition reimbursement available.

• Flexible working environment.

• Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance benefits.

• Employee discount program.