Executive Case Manager

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

📋 Description

• Oversee the entire patient experience from start to finish.

• Conduct benefit investigations thoroughly.

• Monitor prior authorizations and manage denial appeals.

• Assist patients and callers/stakeholders in resolving issues via email, inbound/outbound calls, and Lynk technology.

• Educate on access and reimbursement support tools, program benefits, and eligibility criteria.

• Provide guidance to healthcare providers, patients, and caregivers.

• Train healthcare provider offices on payer processes and procedures.

• Establish strong, trusting relationships with patients, prescribers, and client stakeholders.

• Support incoming and outgoing calls to patients, caregivers, specialty pharmacies, and healthcare professionals.

• Conduct post-benefits-investigation calls to explain coverage options and next steps.

• Manage inquiries from clients and healthcare providers.

• Direct patients to appropriate internal or external resources.

• Offer personalized case management and communicate the next steps for benefit coverage and access.

• Identify needs for prior authorization, appeals, tier exceptions, and formulary exclusions.

• Follow up with payers and healthcare providers regarding submissions and outcomes.

• Coordinate nurse education with nurse educators.

• Support adherence services and identify peer-support resources.

• Oversee prior-authorization reverification and re-enrollment requirements.

• Identify and report adverse events, product complaints, special situation reports, and medical inquiries.

• Document reimbursement activities, claims status, payments, and appeals in Lynk.

• Create reports and analyses to recognize trends and opportunities for improvement.

• Adhere to program procedures, SOPs, corporate policies, and training timelines.

• Undertake additional assigned tasks and projects.

⛳️ Requirements

• A Bachelor's degree or higher is required; healthcare administration, social science, or similar fields are strongly preferred.

• If lacking a degree, a minimum of five years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is required.

• At least two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education is necessary.

• A minimum of two years in healthcare access delivery or management is strongly preferred.

• Other certifications combined with five or more consecutive years of relevant experience may be considered.

• A solid understanding of medical terminology and coding systems, including ICD-10, CPT, and HCPCS is essential.

• Familiarity with insurance processes is required.

• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines, is necessary.

• Exceptional attention to detail and strong organizational skills are a must.

• Capability to prioritize tasks and operate efficiently in a fast-paced environment is essential.

• Strong written and verbal communication skills, along with effective interpersonal abilities, are required.

• Ability to think critically and resolve issues is necessary.

• Bilingual skills are an advantage.

• Eligibility for remote work is contingent upon work-from-home criteria and business needs.

• A typing speed of at least 35 words per minute with 97% accuracy is preferred.

• Flexibility to travel as needed is preferred.

• Successful completion of a background check and, depending on the position, a drug screen is required.

🏝️ Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs.

• Access to Telehealth and Employee Assistance Program (EAP) services.

• Company match on Health Savings Account contributions.

• Free Basic Life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000.

• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability.

• 401(k) Retirement Savings Plan with a 100% match on the first 5% contributed, with immediate vesting.

• Paid Time Off (PTO) and Sick Leave.

• Nine paid holidays plus two floating holidays.

• Opportunities for advancement and personal and professional growth.

• A challenging and stimulating work environment that encourages new ideas.

• An inclusive workplace and mission-driven culture.

• A background check and, depending on the position, a drug screen are required as a condition of employment.