Case Manager, Reimbursement
virtual vocationsDenver (CO)
Case Manager, Reimbursement
Posted today
virtual vocationsDenver (CO)
Claims Adjusters, Examiners, and InvestigatorsPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
SENIORITY
Senior
About the role
To ensure timely case management oversight, the full-time Case Manager, Reimbursement will coordinate assigned caseloads, manage prior authorizations and appeals, and serve as the primary resource for patients and healthcare providers in a remote work environment.
Key responsibilities:
Provide oversight and coordination of caseload to ensure timely completion of all case elements and tasks
Act as the single point of contact for prior authorization and appeal processing communications with patients and external stakeholders
Assess and refer patients for special programs and perform quality checks on cases, reporting trends to leadership
Required qualifications:
Bachelor's degree or six years of relevant working experience
Two or more years of relevant experience in pharmacy benefit management preferred
Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist preferred
Proficiency in Microsoft Office applications
Knowledge of medical and claims processing terminology
Before you apply
Applying takes about a minute. These four things decide how fast it moves after that.
Your profile is current
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Two examples you can talk through
Not a portfolio — just two pieces of work where you can explain the decisions and what you'd change.
A number in mind
What you're on now and what would make you move. We negotiate better when we know both.
Your notice period
Employers plan around it, and it's the question that stalls offers most often.
Once you apply, someone reads it and calls you before anything reaches the employer — usually within two working days.