Case Manager

Case Manager

This role supports a specialty pharmaceutical patient support program by helping patients access prescribed therapies through benefits support, insurance coordination, pharmacy services, and financial assistance programs. As a Case Manager, you will work directly with patients, healthcare providers, specialty pharmacies, and insurance companies to help resolve coverage and medication access issues. You will manage patient cases from initial contact through final approval or denial while providing an empathetic, patient-centered experience and maintaining strict compliance with company policies and PHI requirements.

Key responsibilities include:

• Monitor system accounts for new patient cases and manage cases from initial contact through final approval or denial.
• Conduct outbound calls to patients to confirm insurance approvals or denials, copays, and specialty pharmacy information.
• Contact insurance companies to obtain and document accurate patient benefit and coverage information.
• Research and resolve complex payer, pharmacy, and patient assistance issues.
• Answer patient questions and concerns regarding the status of their requests for assistance.
• Provide an empathetic and supportive experience to patients, providers, and physician offices.
• Accurately document patient information and case activity in company systems while communicating via telephone.
• Process patient applications according to established policies, procedures, and PHI compliance requirements.
• Conduct research on alternative funding sources and foundations to determine patient eligibility for product assistance.
• Identify, document, and compliantly submit Adverse Events during customer interactions or when receiving supporting documentation.
• Communicate case updates and collaborate with team members and leadership to support timely case resolution.
• Apply company policies, procedures, and job knowledge to complete a variety of assignments.
• Independently resolve complex problems and manage assigned cases within established procedures.

Qualifications and skills include:

• High School Diploma or equivalent required; additional education preferred.
• Previous healthcare experience, particularly in insurance, patient support, or the pharmaceutical industry, preferred.
• Pharmacy Benefits Management (PBM) experience preferred.
• Knowledge of Medicare, Medicaid, and Commercial insurance payer practices and policies preferred.
• Previous prior authorization and appeals experience highly desired.
• Strong verbal and written communication skills with an empathetic, patient-centered approach.
• Ability to multitask while using multiple software programs and communicating with patients or healthcare staff.
• Ability to type a minimum of 40 WPM and accurately document notes while speaking with customers.
• Strong Microsoft Office experience required.
• Experience with Microsoft Teams, Zoom, and other video conferencing platforms.
• Strong attention to detail and commitment to accurate, high-quality documentation.
• Excellent organizational and time management skills with the ability to prioritize multiple assignments in a high-volume environment.
• Ability to work independently, demonstrate initiative, and maintain productivity while working remotely.
• Strong work ethic with the ability to meet daily and weekly performance metrics.
• Ability to learn continuously and adapt to new processes, systems, and responsibilities.
• Strong commitment to attendance, reliability, teamwork, and company policies.

Remote requirements include:

• U.S. residents only.
• Dedicated, quiet, private, and distraction-free workspace.
• Secure, high-speed broadband internet connection through DSL, Cable, or Fiber.
• Minimum download speed of 15 Mbps.
• Minimum upload speed of 5 Mbps.
• Maximum ping rate of 30 ms.
• Hardwired Ethernet connection to the router required.
• Wi-Fi, satellite, and cellular internet connections are not acceptable.
• Surge protector with network line protection required for company-issued equipment.
• Company will provide the computer, technology, and equipment needed to perform the job.
• Employee is responsible for maintaining the required high-speed internet connection.