Case Manager
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Job Description
Case Manager supporting U.S. patient access, reimbursement, and therapy initiation for a biotechnology company. Managing benefits investigations, authorizations, appeals, and assistance programs.
Responsibilities:
- Manage assigned patient cases from referral through therapy initiation
- Conduct benefits investigations to determine coverage, prior authorization requirements, and patient financial responsibility
- Manage prior authorization and appeals processes, including initiating, submitting, tracking, and following up on requests
- Facilitate patient enrollment in copay and patient assistance programs
- Support communications with patients, healthcare providers, payers, and specialty pharmacies
- Provide education on insurance coverage, access pathways, and treatment journey next steps
- Collaborate with internal teams and external partners to ensure timely therapy initiation and adherence to service level agreements
- Document case activity accurately within HUB systems in compliance with SOPs and regulatory requirements
- Monitor case progress and escalate complex reimbursement issues
- Respond to incoming calls from patients, caregivers, and prescriber offices
- Track and resolve escalations with leadership support
- Support quality initiatives, audits, and continuous process improvement
- Ensure compliance with HIPAA, privacy, and regulatory standards
Requirements:
- Bachelor’s Degree or equivalent experience preferred
- Experience in patient access, HUB services, reimbursement support, specialty pharmacy, or healthcare case management preferred
- Working knowledge of benefits investigation, prior authorization, appeals, and patient assistance programs
- Strong communication and interpersonal skills with a patient-focused approach
- Ability to manage a high volume of cases in a fast-paced environment while meeting service level expectations
- Proficiency with CRM systems and Microsoft Office applications
- Strong organizational, analytical, and problem-solving skills
- Ability to prioritize workload and manage multiple tasks effectively
- Compliance with HIPAA, privacy, and regulatory standards
Benefits:
- Competitive pay
- Medical, dental, and vision coverage
- Accrued paid time off
- 401(k) with company match
- Disability and life insurance
- Paid maternity and paternity leave
- Company-paid holidays
- Recognition programs, contests, and awards
- Learning, leadership development, and career advancement support
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