Case Manager, Reimbursement

Job Summary

To ensure timely case management oversight, the full-time Case Manager, Reimbursement will coordinate assigned caseloads, manage prior authorizations and appeals, and serve as the primary resource for patients and healthcare providers in a remote work environment.

Key responsibilities

• Provide oversight and coordination of caseload to ensure timely completion of all case elements and tasks
• Act as the single point of contact for prior authorization and appeal processing communications with patients and external stakeholders
• Assess and refer patients for special programs and perform quality checks on cases, reporting trends to leadership

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
• Proficiency in Microsoft Office applications
• Knowledge of medical and claims processing terminology