Senior Case Manager, Reimbursement

Job Summary

To support a growing pharmaceutical support team, the full-time Senior Case Manager, Reimbursement will manage a caseload, ensuring timely completion of prior authorizations and appeals, while acting as a primary resource for patients and healthcare providers.

Key responsibilities

• Provide day-to-day 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, healthcare providers, and field representatives
• Serve as a patient advocate, assisting patients in navigating the reimbursement process and coordinating additional access services

Required qualifications

• Bachelor's degree or six years of relevant working experience
• Five or more years of relevant experience in pharmacy benefit management, specialty pharmacy, or patient support/access services preferred
• Three or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization, and/or appeals required
• Medical Assistant, Social Worker, or Senior Reimbursement Specialist experience preferred
• Proficient in Microsoft Office applications and knowledgeable in medical and claims processing terminology