Pharmacy Patient Care Case Manager

The Impact of this Role

The Pharmacy Patient Care Case Manager serves as the primary liaison between patients, healthcare providers, infusion service providers, specialty pharmacies, and health plan stakeholders to facilitate appropriate, cost-effective, and clinically suitable infusion care. This role is responsible for coordinating patient placement across home infusion, ambulatory infusion centers, physician office infusion suites, and health system outpatient infusion centers while ensuring continuity of care, reimbursement alignment, and positive patient outcomes.

What You’ll be Doing

• Patient Site-of-Care Coordination
• Assess patient-specific clinical, financial, geographic, and benefit plan factors to determine the most appropriate infusion site of care.
• Collaborate with patients, caregivers, physicians, pharmacists, nurses, and infusion providers to ensure timely initiation and continuation of therapy.
• Maintain accurate case records, provider communications, and documentation of negotiation outcomes, reimbursement agreements, and patient placement decisions, ensuring compliance with company policies, payer requirements, and applicable regulations.
• Monitor patient case progression and proactively resolve barriers to treatment access.
• Ensure continuity of care throughout site transitions, therapy changes, and provider referrals.
• Provider Relations & Contract Negotiation
• Negotiate reimbursement rates, service agreements, and provider contracts with infusion providers, health systems, ambulatory infusion centers, and home infusion organizations, reviewing terms and legal language for accuracy and compliance.
• Own end-to-end facilitation and negotiation of single-case agreements and letters of agreement when network participation is unavailable or insufficient.
• Develop and maintain productive relationships with provider organizations and key stakeholders, balancing patient access needs, provider expectations, and organizational cost-management objectives.
• Identify financial, operational, and contractual risks associated with provider arrangements.
• Collaborate with legal, contracting, network management, and finance teams to finalize agreements.
• Escalate complex negotiations and reimbursement issues as necessary.
• Case Management & Documentation
• Track key performance indicators including treatment initiation timelines, savings opportunities, network utilization, and patient satisfaction.
• Participate in quality improvement initiatives and process optimization efforts.

Who You’ll be Working With

In this role, you would work closely with a wide range of internal and external healthcare partners. Most frequently, you would collaborate with patients and their caregivers, as well as physicians, pharmacists, nurses, and infusion service providers to coordinate care and ensure timely treatment. You would also partner with specialty pharmacies, home infusion organizations, infusion centers, and health system stakeholders to determine appropriate sites of care. Internally, you would engage with teams such as finance, contracting, and network management to negotiate agreements and support reimbursement strategies.

Skills and Experience You’ll Bring to the Table

• Bachelor’s degree in Healthcare Administration, Business, Nursing, Pharmacy, or related field preferred
• 3–5+ years of experience in healthcare case management, specialty pharmacy, infusion services, provider relations, managed care, or healthcare contracting required
• Experience coordinating infusion therapies and alternative sites of care preferred
• Experience reviewing contracts, agreements, or reimbursement arrangements required
• Strong knowledge of healthcare reimbursement methodologies and payer operations required
• CNA, LPN, RN, or other clinical credential preferred
• Certification in Case Management (CCM) or related credential preferred

Competencies You’ll Bring to the Table

• Patient Advocacy
• Financial Analysis
• Relationship Management
• Clinical Care Coordination
• Problem Resolution
• Provider Negotiation
• Conflict Resolution
• Cross-Functional Collaboration and Communication

Work Environment

This is a full-time role with occasional on-site collaboration at OptiMed’s headquarters in Kalamazoo, Michigan. The role operates in a fast-paced environment where multiple projects and integrations are managed simultaneously. The position requires prolonged computer use and the ability to work across multiple systems and tools daily. Occasional on-site presence may be required for collaboration, system setup, or project needs.

Company Information

OptiMed Health Partners optimizes health outcomes and quality of life through personalized and coordinated care. We have been serving patients for over 30 years with a focus on high-quality care in retail pharmacy, specialty pharmacy, and infusion services. The OptiMed Vision reimagines healthcare solutions to achieve unsurpassed value. Our results-oriented culture fosters learning, providing growth opportunities for our employees and exceptional care for our patients in all 50 states.