FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management oversight, including prior authorization and appeals processing, while effectively collaborating with healthcare providers and stakeholders. Proficient in managing complex reimbursement cases and ensuring compliance with pharmaceutical requirements.
Highest-signal resume keywords
Case Management OversightPrior Authorization ProcessingPharmacy Benefit ManagementMedical Benefit VerificationCritical Thinking
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Pharmacy Benefit ManagementPrior AuthorizationMedical Benefit VerificationComplex Reimbursement Case ManagementQuality ChecksAdverse Drug Event ReportingPatient AdvocacyClaims Processing TerminologyProcess ImprovementMulti-tasking
Soft Skills
Excellent CommunicationMentoringCollaborationProblem SolvingInstruction Providing
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Medical AssistantSocial WorkerSenior Reimbursement Specialist
Industry Keywords
Patient Support ServicesReimbursement ProcessHealthcare ProvidersStakeholder EngagementQuality Trends
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
- Serve as a patient advocate and resource throughout the reimbursement process
- Coordinate additional patient access services within program guidelines
- Perform quality checks on cases and report trends to leadership
- 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 the manufacturer
- Assist case managers with prior authorization and appeal requirements, process questions, and escalations
- Support at-risk patients and prescribers to mitigate lapses in therapy
- Collaborate with senior case managers, managers, and the quality team on quality trends and process improvement initiatives
- Prepare and present team huddles and client presentations, with a minimum of one presentation per month
- Serve as an account manager for prescribers when assigned
- Share best practices and territory trends with client field teams
- Mentor and/or lead other case managers
- Manage work in progress to acceptable quality and productivity standards
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree or six years of relevant working experience
- Five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred
- Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- 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
- Ability to multi-task
- Experience with Pharmacy Benefit Management, complex reimbursement case management, and pharmacy reimbursement hubs
- Ability to work with patients, healthcare providers, field reimbursement representatives, prescribers, and other stakeholders
- Ability to comply with applicable company, state and federal safety and environmental programs and procedures
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