REMOTE HEALTHCARE CASE MANAGER - PATIENT SUPPORT - {176943}

Job Description

Job Description

REMOTE HEALTHCARE CASE MANAGER – PATIENT SUPPORT

Pay Rate: $20/hour
Schedule: Monday–Friday, 8:00 AM–5:00 PM CST
Location: 100% Remote
Hours: Full-time, 40 hours/week

JOB OVERVIEW

We are seeking a Healthcare Case Manager to support patients who are accessing specialty medications and related services. This role guides patients through the medication access process, helps resolve insurance and coverage questions, and coordinates with patients, healthcare providers, specialty pharmacies, and insurance companies.

The ideal candidate has experience in healthcare customer service, insurance, Medicare, pharmacy benefits, patient support, prior authorization, insurance verification, pharmacy, or a high-volume healthcare call center.

This is a patient-facing role that requires strong communication, accurate documentation, attention to detail, and the ability to manage multiple systems and cases in a fast-paced environment.

KEY RESPONSIBILITIES

• Support patients throughout the medication access process, from benefit verification through medication delivery.

• Conduct insurance benefit verifications and help patients understand coverage, eligibility, deductibles, out-of-pocket costs, and available options.

• Work with physician offices, specialty pharmacies, insurance companies, and patients to obtain and clarify required information.

• Assist with prior authorization, appeals, coverage questions, and resolution of insurance-related issues.

• Respond to inbound calls from patients, healthcare providers, specialty pharmacies, and other representatives.

• Provide clear explanations regarding insurance coverage, assistance requests, case status, and next steps.

• Review enrollment forms and supporting documentation for completeness and accuracy.

• Process enrollments and case information received through fax, phone, and electronic channels.

• Document patient and case information accurately in multiple computer systems.

• Research and resolve questions while working toward one-call resolution whenever possible.

• Escalate complex issues appropriately while maintaining ownership of the case through resolution.

• Protect patient information and follow HIPAA, privacy, and company requirements.

• Meet established productivity, quality, documentation, and turnaround-time expectations.

QUALIFICATIONS

• High school diploma or equivalent preferred.

• Experience in healthcare, insurance, pharmacy, patient support, member services, medical billing, prior authorization, insurance verification, or a high-volume customer service/call center environment.

• Strong verbal and written communication skills.

• Ability to explain complex insurance or healthcare information clearly and professionally.

• Strong attention to detail and accurate data entry/documentation skills.

• Comfortable navigating multiple computer systems and applications simultaneously.

• Strong problem-solving, multitasking, organization, and follow-through skills.

• Ability to work effectively with patients, healthcare providers, pharmacies, and insurance representatives.

• Understanding of healthcare terminology and patient confidentiality/HIPAA requirements.

• Ability to work in a structured, metrics-driven environment while maintaining a high level of customer service.

PREFERRED EXPERIENCE

Candidates with experience in any of the following areas are encouraged to apply:

• Medicare or Medicare Part D

• Medicaid or commercial insurance

• Pharmacy benefits/PBM

• Pharmacy technician experience

• Prior authorization

• Insurance verification or benefits investigation

• Patient assistance programs

• Specialty pharmacy

• Healthcare member services

• Patient support or case management

• Medical billing or claims

• Healthcare call center/customer service

TRAINING REQUIREMENTS

Mandatory virtual training will be held Monday–Friday from 8:00 AM–5:00 PM CST.

100% attendance is required during training. Candidates must be available for the complete training schedule, and pre-planned time off during training will not be accepted.

REMOTE WORK REQUIREMENTS

• Dedicated, quiet, private workspace free from distractions.

• Reliable high-speed broadband internet through DSL, cable, or fiber.

• Dial-up, satellite, Wi-Fi-only, and cellular internet connections are not acceptable.

• Minimum internet speed: 15 Mbps download / 5 Mbps upload.

• Maximum ping: 30ms.

• Hardwired connection from the computer to the router is required.

• Surge protector with network line protection is required.

• Company-provided equipment will be supplied.

WHO THIS ROLE IS A GOOD FIT FOR

This position may be a strong fit for someone coming from a healthcare call center, Medicare member services, insurance enrollment, pharmacy benefits, pharmacy technician, prior authorization, insurance verification, patient support, medical billing, or healthcare customer service background.

Direct specialty pharmacy or formal Case Manager experience is helpful but is not required.