Case Manager

Job Summary

A company is looking for a Case Manager.

Key Responsibilities

• Monitor system accounts for new patient cases and conduct outbound calls to confirm coverage details
• Resolve complex payer/pharmacy issues and maintain quality support for patients and providers
• Enter detailed information into proprietary software and manage patient accounts from initial contact through final approval/denial

Required Qualifications

• Minimum of a high school diploma; additional education preferred
• Previous healthcare experience with insurance or in the pharmaceutical industry preferred
• Experience in pharmacy benefits management preferred
• Knowledge of Medicare, Medicaid, and commercially insured payer practices and policies
• Prior authorization and appeals experience highly desired