Specialty Patient Case Manager (100% Remote)

The Opportunity Operating within an exclusive, integrated model that connects pharmaceutical manufacturers directly to the patient experience, you will serve as a dedicated advocate. In this role, you will navigate the complexities of healthcare insurance, pharmacy benefits, and financial programs to ensure patients can quickly access and complete their life-critical therapies. Location: 100% Work-From-Home / Remote (U.S. Based) Compensation: $20.00/hr Contract Type: Full-Time Assignment with long-term growth potential Onboarding & Schedule

• Mandatory Virtual Training:

4–6 weeks | Monday – Friday, 8:00 AM – 5:00 PM CST.

• Operational Shift:

Ability to work any assigned 8-hour shift between 7:00 AM – 7:00 PM CST .

• Attendance:

Strict adherence to attendance policies is required for both training and active production.

Key Responsibilities

• Case Stewardship:

Manage patient accounts from initial contact through final approval or denial, ensuring a seamless journey.

• Insurance Coordination:

Contact payers to obtain accurate benefit information and verify coverage for Medicare, Medicaid, and commercial plans.

• Complex Problem Solving:

Mediate and resolve intricate payer or pharmacy issues to achieve positive outcomes for the patient.

• Outbound Outreach:

Confirm co-pays, coverage details, and specialty pharmacy dispensing via professional outbound calls.

• Compliance & Safety:

Document all interactions in real-time within proprietary software and identify/submit Adverse Events according to strict PHI and program guidelines.

• Funding Research:

Investigate alternative funding and foundation eligibility to assist patients with medication costs.

Required Qualifications

• Experience:

Previous experience in Pharmacy Benefits Management (PBM), insurance verification, or the pharmaceutical industry is highly preferred.

• Specialized Knowledge:

Prior experience with Prior Authorizations and Appeals is a significant advantage.

• Technical Skills:
• Minimum typing speed of 40 WPM.
• Ability to transcribe accurate notes while speaking with customers.
• Proficiency in Microsoft Office, Zoom, and Microsoft Teams.
• Soft Skills:

Exceptional empathy, professional verbal communication, and a "quality-first" mindset. Remote Work Requirements You must provide a dedicated, private, and distraction-free workspace. All necessary computer equipment will be provided. Your home office must meet the following internet specifications:

• Connection:

Secure, high-speed Broadband (DSL, Cable, or Fiber). WiFi, Satellite, and Cellular connections are not acceptable.

• Speeds:

15Mbps Download / 5Mbps Upload / Max 30ms Ping Rate.

• Setup:

Connection must be hardwired directly to the router. Why Join This Team? We offer a flexible technology platform and a supportive team environment where your work has a direct, measurable impact on patient health. This is an ideal path for those seeking to move into senior-level roles within the pharmaceutical services industry. Apply tot his job Apply To this Job