Case Manager – Reimbursement

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

📋 Description

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

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

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

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

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients to specialized programs and services as necessary.

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

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

• Address complex cases across various disease states.

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

• Report Adverse Drug Events in line with pharmaceutical regulations.

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

• Execute additional tasks as assigned.

⛳️ Requirements

• A Bachelor’s degree or six years of pertinent work 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.

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

• Strong critical thinking abilities.

• Capable of handling multiple tasks simultaneously.

• Able to work a shift schedule from 11:00am to 08:00pm EST.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement assistance.

• Flexible work environment.

• Discretionary Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine services (Virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance policies.

• Access to discount programs.