Specialty Patient Case Manager (100% Remote)

The Opportunity

Operating within an exclusive, integrated model that connects pharmaceutical manufacturers directly to the patient experience, you will serve as a dedicated advocate. In this role, you will navigate the complexities of healthcare insurance, pharmacy benefits, and financial programs to ensure patients can quickly access and complete their life-critical therapies.

Location: 100% Work-From-Home / Remote (U.S. Based)

Compensation: $20.00/hr

Contract Type: Full-Time Assignment with long-term growth potential

Onboarding & Schedule

• Mandatory Virtual Training: 4--6 weeks | Monday -- Friday, 8:00 AM -- 5:00 PM CST.
• Operational Shift: Ability to work any assigned 8-hour shift between 7:00 AM -- 7:00 PM CST.
• Attendance: Strict adherence to attendance policies is required for both training and active production.

Key Responsibilities

• Case Stewardship: Manage patient accounts from initial contact through final approval or denial, ensuring a seamless journey.
• Insurance Coordination: Contact payers to obtain accurate benefit information and verify coverage for Medicare, Medicaid, and commercial plans.
• Complex Problem Solving: Mediate and resolve intricate payer or pharmacy issues to achieve positive outcomes for the patient.
• Outbound Outreach: Confirm co-pays, coverage details, and specialty pharmacy dispensing via professional outbound calls.
• Compliance & Safety: Document all interactions in real-time within proprietary software and identify/submit Adverse Events according to strict PHI and program guidelines.
• Funding Research: Investigate alternative funding and foundation eligibility to assist patients with medication costs.

Required Qualifications

• Experience: Previous experience in Pharmacy Benefits Management (PBM), insurance verification, or the pharmaceutical industry is highly preferred.
• Specialized Knowledge: Prior experience with Prior Authorizations and Appeals is a significant advantage.
• Technical Skills:
  • Minimum typing speed of 40 WPM.
  • Ability to transcribe accurate notes while speaking with customers.
  • Proficiency in Microsoft Office, Zoom, and Microsoft Teams.
• Soft Skills: Exceptional empathy, professional verbal communication, and a "quality-first" mindset.

Remote Work Requirements

You must provide a dedicated, private, and distraction-free workspace. All necessary computer equipment will be provided. Your home office must meet the following internet specifications:

• Connection: Secure, high-speed Broadband (DSL, Cable, or Fiber). WiFi, Satellite, and Cellular connections are not acceptable.
• Speeds: 15Mbps Download / 5Mbps Upload / Max 30ms Ping Rate.
• Setup: Connection must be hardwired directly to the router.

Why Join This Team?

We offer a flexible technology platform and a supportive team environment where your work has a direct, measurable impact on patient health. This is an ideal path for those seeking to move into senior-level roles within the pharmaceutical services industry.