Case Manager, Reimbursement

Job Summary

Providing day-to-day case management oversight, the full-time remote Case Manager, Reimbursement will coordinate assigned caseloads, ensuring timely completion of prior authorizations, appeals, and eligibility assessments for additional services.

Key responsibilities

• Oversee and coordinate caseload to ensure timely completion of all case elements and tasks
• Act as the primary contact for prior authorization and appeal processing communications with patients and healthcare providers
• Assess and refer patients for special programs/services as needed, while performing quality checks on cases

Required qualifications

• Bachelor's degree or six years of relevant working experience
• Two or more years of relevant experience in pharmacy benefit management preferred
• Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist preferred
• Proficient in Microsoft Office applications
• Knowledge of medical and claims processing terminology