Senior Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate the daily activities of an assigned caseload.

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

• Act as the primary contact for communications regarding prior authorization and appeal processing.

• Provide support to patients, healthcare providers, field reimbursement representatives, and other external stakeholders.

• Function as a patient advocate and resource while managing additional patient access services in accordance with program guidelines.

• Act as the account manager for prescribers, delivering case updates and informative resources.

• Collaborate with the client’s field team to exchange best practices, analyze territory trends, resolve escalations, and address prescriber-related concerns.

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

• Uphold quality and production standards while adhering to company, state, and federal safety and environmental policies and procedures.

• Troubleshoot complex cases across various disease states.

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

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

• Assist case managers with prior authorization and appeal requirements, processing inquiries, and escalations.

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

• Collaborate monthly with senior case managers, managers, and the quality team to analyze quality trends and develop process improvement initiatives.

• Prepare and deliver team huddles and client presentations, ensuring a minimum of one presentation per month.

• Serve as a mentor and/or lead for other case managers.

• Perform additional duties as assigned.

⛳️ Requirements

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

• Preferred: Five (5) or more years of experience in pharmacy benefit management, specialty pharmacy, or patient support/access (HUB) services.

• Required: Three (3) or more years of 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.

• Knowledgeable in medical and claims processing terminology.

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

• Must demonstrate strong critical thinking skills and the capability to multitask.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching.

• Tuition reimbursement program.

• Flexible working environment.

• 20 days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Access to telemedicine (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term and long-term disability coverage.

• Life insurance options.

• Various discount programs.