Senior 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 assigned caseloads.

• Ensure timely completion of case elements and tasks to facilitate the progression of cases through the required processes.

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

• Act as a patient advocate and provide resources throughout the reimbursement journey.

• Coordinate additional patient access services in alignment with program guidelines.

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

• Address complex cases that involve multiple disease states.

• Collaborate with both internal and external stakeholders to ensure a smooth initiation of therapy.

• Report Adverse Drug Events in compliance with pharmaceutical regulations.

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

• Assist case managers with prior authorization and appeal processes, queries, and escalations.

• Support at-risk patients and prescribers to prevent interruptions in therapy.

• Work in partnership with senior case managers, managers, and the quality team on quality trends and process improvement initiatives.

• Prepare and deliver team huddles and client presentations, ensuring at least one presentation per month.

• Serve as an account manager for prescribers when assigned.

• Share best practices and territory insights with client field teams.

• Mentor and/or lead fellow case managers.

• Maintain work in progress to meet established quality and productivity standards.

• Perform additional duties as assigned.

⛳️ Requirements

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

• Preferably five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy, or patient support/access (HUB) services.

• Required three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization, and/or appeals.

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

• 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 abilities are essential.

• Capability to manage multiple tasks simultaneously.

• Experience in Pharmacy Benefit Management, complex reimbursement case management, and pharmacy reimbursement hubs is a plus.

• Ability to engage with patients, healthcare providers, field reimbursement representatives, prescribers, and other stakeholders.

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

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Advancement opportunities for career growth.

• 401K plan with company matching contributions.

• Tuition reimbursement programs.

• Flexible work environment.

• 20 Days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

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

• Access to telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term and long-term disability coverage.

• Life insurance benefits.

• Various discount programs.