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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management oversight and coordination, ensuring timely processing of patient cases while adhering to quality and safety standards. Proficient in communication and critical thinking, with a strong understanding of medical terminology and pharmacy benefit management.
Highest-signal resume keywords
Case Management OversightPharmacy Benefit ManagementMedical Terminology KnowledgeExcellent Written/Verbal CommunicationCritical Thinking Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementQuality ChecksAdverse Drug Events ReportingMedical Claims ProcessingMulti-tasking
Soft Skills
CommunicationCritical ThinkingTime Management
Tools & Technologies
MicroSoft Office
Certifications & Qualifications
Medical Assistant CertificationSocial Worker CertificationSenior Reimbursement Specialist Certification
Industry Keywords
Patient BenefitsPrior AuthorizationAppeal ProcessingProduct Quality ComplaintsSpecial Programs/Services
About the role
Key responsibilities & impact- Provide day-to-day case management oversight and coordination of assigned caseload
- Ensure case elements and tasks are completed timely and cases move through the process as required
- Act as the single point of contact for prior authorization and appeal processing communications
- Communicate patient benefits and responsibility accurately and timely
- Assess and refer patients for special programs/services when appropriate
- Perform quality checks on cases and report trends to leadership
- Adhere to quality, production, safety, environmental, and company procedures
- Troubleshoot complex cases across multiple disease states with internal and external stakeholders
- Report Adverse Drug Events according to pharmaceutical requirements
- Recognize product quality complaints and forward information to the manufacturer
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree or six years of relevant working experience
- Two (2) or more years of relevant experience in pharmacy benefit management preferred
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- Certification preferred but not required
- Proficient in MicroSoft Office applications
- Knowledge of medical and claims processing terminology
- Excellent written/verbal communication to include providing clear instructions
- Strong critical thinking skillset
- Ability to multi-task
- 8-hour workday between 8am and 8pm EST
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match
- Tuition reimbursement
- Flexible work environment
- 20 Days PTO (Paid Time Off)
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs