Executive Case Manager (Remote)

About the role

The Executive Case Manager role at Valeris is a remote position based in Florida. This role involves managing patient journeys from initiation to closure, providing personalized case management, and handling complex reimbursement inquiries.

Responsibilities

• Builds trusted relationships with patients, prescribers, and stakeholders regarding reimbursement inquiries and challenges through proactive communication and timely execution of deliverables.
• Manages all relationships in compliance with relevant laws, regulations, and industry standards, including HIPAA and insurance guidelines.
• Supports inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals.
• Performs post-Benefit Investigation calls to explain coverage options and next steps in the access journey.
• Manages client inquiries and HCP inquiries as per business rules.
• Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigations as needed.
• Serves as a subject matter expert to internal team as required and appropriate.
• Utilizes Valeris’ values as the driving force behind the team’s success.
• Performs additional tasks or projects as assigned.

Qualifications

• Completion of a Bachelor's degree (or higher) required, preferably in healthcare administration, social science, or a similar related field.
• Minimum two years of experience in healthcare access delivery or management, or five or more consecutive years of experience in relevant fields like insurance reimbursement, patient access, direct patient care, and patient education.
• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
• Demonstrated examples of executing within guardrails recognizing urgency and consistently delivering patient-centric results.
• Excellent attention to detail and organizational skills.
• Able to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, with the ability to interact professionally with diverse stakeholders.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.

Benefits

Valeris offers a comprehensive benefits package including medical, dental, and vision plans, with HSA- and FSA-eligible options, and a company match on Health Savings Account contributions. Other benefits include a 401(k) retirement savings plan with a 100% match on the first 5% contributed, free basic life and AD&D coverage, and a company-paid Short-Term Disability plan with the option to purchase Long-Term Disability. Team members also receive nine paid holidays plus two floating holidays, opportunities for advancement, and a challenging, stimulating work environment.

Pay

Details on pay are not specified in the job posting.

Schedule

The role operates remotely.