Executive Case Manager

Valeris

. Manage the patient journey from initiation to closure .

Posted 11/11/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in patient access management, insurance reimbursement processes, and healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines. Proficient in medical terminology and coding systems such as ICD-10, CPT, and HCPCS, with strong communication and organizational skills to effectively manage patient journeys and inquiries.

Highest-signal resume keywords

Patient Access ManagementInsurance ReimbursementHealthcare Compliance RegulationsMedical Terminology and CodingEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10CPTHCPCSInsurance ProcessesBenefit InvestigationsPrior AuthorizationsCase ManagementClaims Status DocumentationTrend AnalysisPatient Education

Soft Skills

Attention to DetailOrganizational SkillsCritical ThinkingInterpersonal SkillsAbility to Prioritize Tasks

Tools & Technologies

Lynk Technology

Industry Keywords

Healthcare AdministrationPatient CarePatient EducationHIPAAMedicareMedicaid

About the role

Key responsibilities & impact

Manage the patient journey from initiation to closure
Complete benefit investigations
Track prior authorizations and denial appeals
Assist patients and callers/stakeholders through resolution via email, inbound/outbound calls, and Lynk technology
Provide education on access and reimbursement support tools, program benefits, and eligibility
Advise healthcare providers, patients, and caregivers
Educate healthcare provider offices on payer processes and procedures
Build trusted relationships with patients, prescribers, and client stakeholders
Support inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals
Perform post-benefits-investigation calls explaining coverage options and next steps
Manage client and healthcare provider inquiries
Triage patients to internal or external resources
Provide personalized case management and communicate benefit coverage and access next steps
Identify prior authorization, appeal, tier exception, and formulary exclusion needs
Follow up with payers and healthcare providers on submissions and outcomes
Coordinate nurse teaching with nurse educators
Support adherence services and identify peer-support resources
Manage prior-authorization reverification and re-enrollment needs
Identify and report adverse events, product complaints, special situation reports, and medical inquiries
Document reimbursement activities, claims status, payments, and appeals in Lynk
Generate reports and analysis to identify trends and improvement opportunities
Follow program procedures, SOPs, corporate policies, and training deadlines
Perform additional assigned tasks and projects

Requirements

What you’ll need

Completion of Bachelor's degree or higher required; healthcare administration, social science, or similar fields strongly preferred
In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required
Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required
Minimum two years of experience in healthcare access delivery or management strongly preferred
Other certifications and five or more consecutive years of relevant experience may be considered
Strong understanding of medical terminology and coding systems including ICD-10, CPT, and HCPCS
Knowledge of insurance processes
Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines
Excellent attention to detail and organizational skills
Ability to prioritize tasks and work efficiently in a fast-paced environment
Effective written and verbal communication and interpersonal skills
Ability to think critically and resolve issues
Bilingual skills are a plus
Remote work eligibility subject to work-from-home criteria and business need
Ability to type at least 35 words per minute with 97% accuracy preferred
Flexibility to travel as needed preferred
Successful completion of a background check and, depending on the position, a drug screen

Benefits

Comp & perks

Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
Telehealth and Employee Assistance Program (EAP) services
Company match on Health Savings Account contributions
Free Basic Life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000
Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
401(k) Retirement Savings Plan with 100% match on the first 5% contributed, with immediate vesting
Paid Time Off (PTO) and Sick Leave
Nine paid holidays plus two floating holidays
Opportunities for advancement and personal and professional growth
Challenging, stimulating work environment encouraging new ideas
Inclusive workplace and mission-driven culture
Background check and, depending on the position, drug screen required as a condition of employment