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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 completion of tasks and effective communication with stakeholders. Proficient in assessing patient needs and adhering to quality standards in pharmacy benefit management.
Highest-signal resume keywords
Case Management OversightPharmacy Benefit ManagementMedical Terminology KnowledgeCritical Thinking SkillsMicrosoft Office Proficiency
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 CoordinationQuality ChecksAdverse Drug Event ReportingClaims ProcessingPatient Assessment
Soft Skills
Excellent CommunicationMulti-tasking AbilityProblem-solving Skills
Certifications & Qualifications
Medical Assistant CertificationSocial Worker CertificationSenior Reimbursement Specialist Certification
Industry Keywords
Patient BenefitsPrior AuthorizationAppeal ProcessingProduct Quality ComplaintsSafety and Environmental Programs
About the role
Key responsibilities & impact- Provide day-to-day case management oversight and coordination of assigned caseload
- Ensure all case elements and tasks are completed timely and cases move through the process as required
- Act as single point of contact for prior authorization and appeal processing communications
- Communicate patient benefits and responsibility timely and accurately
- Assess and refer patients for special programs/services when appropriate
- Perform quality checks on cases and report trends to leadership
- Adhere to quality and production standards and applicable safety and environmental programs
- Troubleshoot complex cases spanning multiple disease states
- Interface with internal and external stakeholders to ensure optimal start to therapy
- Report Adverse Drug Events in accordance with pharmaceutical requirements
- Recognize product quality complaints and forward information to a 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
- Must possess a strong critical thinking skillset along with the ability to multi-task
- Must work an 8 hour workday between the hours of 8am - 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