This is a remote role. Candidates must reside in the state of Ohio. When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients ...
This is a remote role. Candidates must reside in the state of Ohio. When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients ...
Executive Case Manager (Remote)
Cincinnati, OH ยท On-site +1
This is a remote role. Candidates must reside in the state of Ohio. When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients ...
Executive Case Manager (Remote)
Cincinnati, OH ยท On-site +1
This is a remote role. Candidates must reside in the state of Ohio. When you join the team as an Executive Case Manager, you'll have the opportunity to make a difference in the lives of our patients ...
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Case Manager Employment Type: Contract, 6 months with possibility of extension Employer: Kelly ... Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH;
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Case Manager Employment Type: Contract, 6 months with possibility of extension Employer: Kelly ... Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH;
If you answered "yes" to any of these questions - this is the position for you! RN Field Behavioral Health Case Manager will work 70% in the field and 30% remote. The patient members that they will ...
If you answered "yes" to any of these questions - this is the position for you! RN Field Behavioral Health Case Manager will work 70% in the field and 30% remote. The patient members that they will ...
Manager of Clinical Services - Case Management Work Arrangements: Full Time Essential Staff Work Location - 75% onsite/25% remote Reports to: Chief Clinical Officer CompDrug is seeking a dynamic ...
Manager of Clinical Services - Case Management Work Arrangements: Full Time Essential Staff Work Location - 75% onsite/25% remote Reports to: Chief Clinical Officer CompDrug is seeking a dynamic ...
Senior Business Immigration Case Manager
Cincinnati, OH ยท Remote
$65K - $105K/yr
The purpose of our Senior Business Immigration Case Manager is toโฏprovide overall team support ... Encourage and set example for positive team morale, even within a remote work environment * Oversee ...
Quick apply
Senior Business Immigration Case Manager
Cincinnati, OH ยท Remote
$65K - $105K/yr
The purpose of our Senior Business Immigration Case Manager is toโฏprovide overall team support ... Encourage and set example for positive team morale, even within a remote work environment * Oversee ...
Senior IBM Case Manager/BAW Developer
Columbus, OH ยท On-site +1
$70K - $140K/yr
Senior IBM Case Manager/BAW Developer will design, develop, integrate, and support Workflow/Case ... Remote roles will also have the opportunity to come together in our offices for moments that matter.
Senior IBM Case Manager/BAW Developer
Columbus, OH ยท On-site +1
$70K - $140K/yr
Senior IBM Case Manager/BAW Developer will design, develop, integrate, and support Workflow/Case ... Remote roles will also have the opportunity to come together in our offices for moments that matter.
Senior IBM Case Manager/BAW Developer
Columbus, OH ยท On-site +1
$70K - $140K/yr
Senior IBM Case Manager/BAW Developer will design, develop, integrate, and support Workflow/Case ... Remote roles will also have the opportunity to come together in our offices for moments that matter.
Senior IBM Case Manager/BAW Developer
Columbus, OH ยท On-site +1
$70K - $140K/yr
Senior IBM Case Manager/BAW Developer will design, develop, integrate, and support Workflow/Case ... Remote roles will also have the opportunity to come together in our offices for moments that matter.
Field Case Manager - Vocational
Cincinnati, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Cincinnati, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Cincinnati, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Cincinnati, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
Sedgwick Field Case Managers work face to face with their injured workers and medical providers to ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH ยท Remote
$71K - $89K/yr
Participate in meetings, case reviews, and operational planning activities as required ... Previous experience in remote clinical management or workflow coordination. Key Competencies
Quick apply
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH ยท Remote
$71K - $89K/yr
Participate in meetings, case reviews, and operational planning activities as required ... Previous experience in remote clinical management or workflow coordination. Key Competencies
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH ยท Remote
$71K - $89K/yr
Participate in meetings, case reviews, and operational planning activities as required ... Previous experience in remote clinical management or workflow coordination. Key Competencies
Quick apply
RN Hospice Workflow Specialist/ Weekend Manager REMOTE
Cincinnati, OH ยท Remote
$71K - $89K/yr
Participate in meetings, case reviews, and operational planning activities as required ... Previous experience in remote clinical management or workflow coordination. Key Competencies
Retail Account Manager - Remote
Maumee, OH ยท On-site +1
... break; case 'BusinessUnit': icon = 'glyphicon-briefcase'; break; case 'JobCategory': icon ... Remote Job Title: Retail Account Manager - Remote The Impact You'll Make Imagine yourself as a key ...
Retail Account Manager - Remote
Maumee, OH ยท On-site +1
... break; case 'BusinessUnit': icon = 'glyphicon-briefcase'; break; case 'JobCategory': icon ... Remote Job Title: Retail Account Manager - Remote The Impact You'll Make Imagine yourself as a key ...
Chronic Care Manager (Remote - Compact States)
New Hampshire, OH ยท Remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home ...
Chronic Care Manager (Remote - Compact States)
New Hampshire, OH ยท Remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home ...
Chronic Care Manager (Remote - Compact States)
Delaware, OH ยท Remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home ...
Chronic Care Manager (Remote - Compact States)
Delaware, OH ยท Remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home ...
Nurse Advocate - Greater Cleveland area
Cleveland, OH ยท On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Cleveland, Ohio Area Job Summary: We are ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
Nurse Advocate - Greater Cleveland area
Cleveland, OH ยท On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Cleveland, Ohio Area Job Summary: We are ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
Experience participating in IEP meetings, acting as case manager, and completing comprehensive case ... Flexible, remote scheduling * No-cost continuing education courses and clinical workshops tailored ...
Quick apply
Experience participating in IEP meetings, acting as case manager, and completing comprehensive case ... Flexible, remote scheduling * No-cost continuing education courses and clinical workshops tailored ...
The Contract Specialist is responsible for managing the lifecycle of contracts, including drafting ... This role will also have responsibility for organizing case files and assisting various legal ...
The Contract Specialist is responsible for managing the lifecycle of contracts, including drafting ... This role will also have responsibility for organizing case files and assisting various legal ...
Ob Case Manager Remote information
What are some common challenges faced by remote OB Case Managers, and how can they be addressed?
What are the key skills and qualifications needed to thrive as an OB Case Manager (Remote), and why are they important?
What is an OB Case Manager (Remote)?
What is the difference between Ob Case Manager Remote vs Obstetric Nurse?
| Aspect | Ob Case Manager Remote | Obstetric Nurse |
|---|---|---|
| Credentials | RN license, case management certification | RN license, obstetric nursing certification |
| Work Environment | Remote, telehealth, case management settings | Hospital, clinic, labor and delivery units |
| Industry Usage | Healthcare, insurance, case management | Hospitals, maternity wards, clinics |
| Job Focus | Coordinating care, patient advocacy remotely | Providing direct obstetric patient care |
Ob Case Manager Remote and Obstetric Nurse roles share clinical credentials but differ mainly in work environment and job focus. Ob Case Managers work remotely to coordinate care and advocate for patients, while Obstetric Nurses provide direct patient care in clinical settings. Both roles are vital in maternal healthcare but serve different functions within the industry.
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 12 days ago
Job description
A typical day in this role will include ownership of your patient journey from initiation to closure by using your critical thinking skills and your knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations / denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology, Lynk). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.
The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Case Manager responsibilities include education on the access and reimbursement support tools available from PharmaCord and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.
- Relationship Management
- Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.
- Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.
- Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
- Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.
- Manages all client inquiries as appropriate, such as case specific statuses.
- Manages HCP inquiries, as applicable, pursuant to business rules.
- All communications with the clientโs field teams will remain compliant and adhere to ways of working protocols outlined between PharmaCord and the client teams. Inbound Call Management
- Manages inbound calls as directed by the program-approved FAQs
- Triage patients to internal or external resources as appropriate.
- Personalized Case Management
- Provides personalized case management to patients and HCPs including outbound communication to HCPs, specialty pharmacies and patients to communicate benefit coverage and/or appropriately help drive next steps in obtaining coverage and/or access to prescribed medicine. All communications for case management will follow the guidelines set forth for the program and only provide information publicly available and/or outlined in the patient insert.
- Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
- Identifies and communicates patientโs plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
- Serves as a subject matter expert to internal team as required and appropriate.
- Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome.
- Coordinates nurse teach with nurse educators, as applicable to program.
- Supports adherence services as applicable to program.
- Identifies peer support resources for patients.
- Proactively communicates needs for reverification of prior authorization or re-enrollment.
- Identifies and reports adverse events, product complaints, special situation reports and/or medical inquiries received in accordance with program operating procedures and the Business Rules.
- Documents all activities within the PharmaCord Lynk system, maintaining detailed records of reimbursement activities, including claims status, payments, and appeals.
- Generate reports and analysis as needed to identify trends and opportunities for improvement.in accordance with business requirements.
- Utilize Valerisโ values as the driving force behind the teamโs success
- On time adherence to training deadlines for all corporate policies and procedures
- Ensure all SOPs are followed with consistency
- Perform additional tasks or projects as assigned
- Completion of Bachelor's degree (or higher) required
- A degree in healthcare administration, social science or similar related fields is strongly preferred.
- Minimum two years of experience in healthcare access delivery or management is strongly preferred.
- 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.
- Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).
- 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.
- Ability 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.
- Demonstrates the ability to think critically and issue resolution.
- Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
- Bi-lingual skills are a plus.
- Remote work eligibility is subject to all work from home criteria met and based on business need
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
- Although very minimal, flexibility to travel as needed is preferred.
- This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
- Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
- Additional health support, including telehealth and Employee Assistance Program (EAP) services
- Company match on Health Savings Account contributions
- Free Basic Life and AD amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
- Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
- 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
- Paid Time Off (PTO) and Sick Leave to support work-life balance
- Team members receive nine paid holidays plus two floating holidays
- Opportunities for advancement in a company that supports personal and professional growth
- A challenging, stimulating work environment that encourages new ideas
- Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
- A mission-driven, inclusive culture where your work makes a meaningful impact
Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official @pharmacord.com and/or @valeris.com, @echo.newtonsoftware.com email address regarding next steps in our interview process.
Please Note:- PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @valeris.com, @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
- We will never request your bank account information at any stage of the hiring process.
- We will never send a check (electronic or physical) to purchase home office equipment.
If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at careers@pharmacord.com