Senior Case Manager, Reimbursement

About Our Client: The organization operates within the pharmaceutical support industry, focusing on enhancing health solutions and improving patient outcomes. It addresses challenges in the drug development and commercialization lifecycle by providing services ranging from clinical trial support to real-world evidence generation. About the Opportunity: The SENIOR CASE MANAGER, REIMBURSEMENT is responsible for overseeing and coordinating case management activities related to pharmacy reimbursement hubs. This role ensures timely and accurate completion of tasks such as prior authorizations, reauthorizations, and appeals while serving as a primary resource and advocate for patients, healthcare providers, and reimbursement teams. The position contributes by improving process efficiency, supporting field teams, mentoring peers, and facilitating communication across stakeholders. Responsibilities: Oversee and coordinate day-to-day caseload management to ensure timely completion of case elements.Act as primary contact for communications involving prior authorization and appeals with patients, providers, and external stakeholders.Advocate for patients navigating the reimbursement process and coordinate access services within program guidelines.Perform quality checks on cases and report trends to leadership.Adhere to quality, production, safety, and environmental standards.Troubleshoot complex cases involving multiple disease states and coordinate with key stakeholders.Report Adverse Drug Events in compliance with pharmaceutical requirements.Identify product quality complaints and forward information to manufacturers.Support case managers with guidance on prior authorization and appeal requirements and address escalated issues.Collaborate with senior case managers and quality teams to review trends and develop process improvements.Prepare and deliver team and client presentations regularly.Perform additional duties as assigned. Requirements: Bachelor’s degree or six years of relevant experience.Five or more years of experience in pharmacy benefit management, specialty pharmacy, or patient support/access services preferred.Three or more years of experience in pharmacy and/or medical benefit verifications, prior authorization, and appeals required.Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist preferred.Proficient with Microsoft Office applications.Knowledge of medical and claims processing terminology.Strong written and verbal communication skills.Critical thinking skills and ability to multitask. Pay Range and Compensation Package: The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors. Benefits & Perks: Remote work opportunitiesCompetitive salariesPromotion and growth opportunities401(k) plan with company matchTuition reimbursementFlexible work environment20 days paid time offPaid holidaysEmployee assistance programsMedical, dental, and vision insuranceHealth Savings Account (HSA) and Flexible Spending Account (FSA)Telemedicine servicesWellness programAdoption assistanceShort-term and long-term disability coverageLife insurance Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.