Senior Case Manager, Reimbursement

Job Summary

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

Key responsibilities

• Provide oversight and coordination of caseload to ensure timely completion of case elements and tasks
• Act as the single point of contact for prior authorization and appeal processing communications with patients and external stakeholders
• Serve as a patient advocate, coordinating access services and troubleshooting complex cases across multiple disease states

Required qualifications

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