This is a remote role. Candidates must reside in the state of North Carolina. When you join the ... processes and procedures. Key Responsibilities: * Relationship Management * Builds trusted ...
This is a remote role. Candidates must reside in the state of North Carolina. When you join the ... processes and procedures. Key Responsibilities: * Relationship Management * Builds trusted ...
Executive Case Manager (Remote)
Raleigh, NC · On-site +1
This is a remote role. Candidates must reside in the state of North Carolina. When you join the ... processes and procedures. Key Responsibilities: * Relationship Management * Builds trusted ...
Executive Case Manager (Remote)
Raleigh, NC · On-site +1
This is a remote role. Candidates must reside in the state of North Carolina. When you join the ... processes and procedures. Key Responsibilities: * Relationship Management * Builds trusted ...
TravelAssist Case Manager
Durham, NC · On-site +1
$19 - $24.50/hr
Excellent knowledge of case management principles, healthcare management, and reimbursement ... remote work arrangement. Details will be discussed during the interview process
TravelAssist Case Manager
Durham, NC · On-site +1
$19 - $24.50/hr
Excellent knowledge of case management principles, healthcare management, and reimbursement ... remote work arrangement. Details will be discussed during the interview process
Remote * Case Volume: 77 RVUs * Case Types: Diagnostic * Must be board-certified Please apply for ... Experience simplified assignment management and timesheet submittals via the Medicus Portal. Unlock ...
Remote * Case Volume: 77 RVUs * Case Types: Diagnostic * Must be board-certified Please apply for ... Experience simplified assignment management and timesheet submittals via the Medicus Portal. Unlock ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · On-site +1
$50K/yr
Empower the patient to participate in their personal care process by triaging the patient to ... Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · On-site +1
$50K/yr
Empower the patient to participate in their personal care process by triaging the patient to ... Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · Remote
$50K/yr
Empower the patient to participate in their personal care process by triaging the patient to ... Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote ...
Remote Registered Nurse (RN) Case Manager
Raleigh, NC · Remote
$50K/yr
Empower the patient to participate in their personal care process by triaging the patient to ... Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote ...
... Case Management as part of Alliance's Multidisciplinary Care Management Team for members with ... The Physical Health Consultant will process and prioritize referrals from Care Management staff to ...
... Case Management as part of Alliance's Multidisciplinary Care Management Team for members with ... The Physical Health Consultant will process and prioritize referrals from Care Management staff to ...
... Case Management as part of Alliance's Multidisciplinary Care Management Team for members with ... The Physical Health Consultant will process and prioritize referrals from Care Management staff to ...
... Case Management as part of Alliance's Multidisciplinary Care Management Team for members with ... The Physical Health Consultant will process and prioritize referrals from Care Management staff to ...
EHR Epic Analyst
Cary, NC · Remote
Remote (Based in Raleigh, NC) Position Type: Contract We are seeking an experienced EHR Epic ... Provide expertise in Epic tools , including Clinical Case Management, Rover, MyChart Bedside ...
Quick apply
EHR Epic Analyst
Cary, NC · Remote
Remote (Based in Raleigh, NC) Position Type: Contract We are seeking an experienced EHR Epic ... Provide expertise in Epic tools , including Clinical Case Management, Rover, MyChart Bedside ...
Case Manager Nurse Advocate- Raleigh area
Raleigh, NC · On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Raleigh Area Job Summary: We are seeking ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
Case Manager Nurse Advocate- Raleigh area
Raleigh, NC · On-site +1
SYNERGY HEALTHCARE: Case Manager Nurse Advocate- Greater Raleigh Area Job Summary: We are seeking ... This opportunity allows for remote work so can be flexible on location. Minimal travel within the ...
SPECIAL NEEDS ADOPTION COORDINATOR
Raleigh, NC · Remote
$48K/yr
Adoption Coordinator (Full-Time | Remote | $48,000) Join Lutheran Services Carolinas and help ... Provide ongoing case management, support, education, and advocacy for foster and adoptive families.
SPECIAL NEEDS ADOPTION COORDINATOR
Raleigh, NC · Remote
$48K/yr
Adoption Coordinator (Full-Time | Remote | $48,000) Join Lutheran Services Carolinas and help ... Provide ongoing case management, support, education, and advocacy for foster and adoptive families.
RN Field Case Manager
Raleigh, NC · On-site +1
$75K - $96K/yr
Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Raleigh, NC · On-site +1
$75K - $96K/yr
Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Raleigh, NC · On-site +1
$75K - $96K/yr
Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Raleigh, NC · On-site +1
$75K - $96K/yr
Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management ... remote work environment that allows face to face interaction with injured workers and medical ...
The Senior Remote Sensing Technician is responsible for post-processing aerial data to final ... Ability to work independently and manage multiple tasks simultaneously. * Willingness to adapt to ...
The Senior Remote Sensing Technician is responsible for post-processing aerial data to final ... Ability to work independently and manage multiple tasks simultaneously. * Willingness to adapt to ...
Senior Remote Sensing Technician
Raleigh, NC · On-site +1
The Senior Remote Sensing Technician is responsible for post-processing aerial data to final ... Ability to work independently and manage multiple tasks simultaneously. * Willingness to adapt to ...
Senior Remote Sensing Technician
Raleigh, NC · On-site +1
The Senior Remote Sensing Technician is responsible for post-processing aerial data to final ... Ability to work independently and manage multiple tasks simultaneously. * Willingness to adapt to ...
Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality ... Proficient in Utilization Review process including benefit interpretation, contract language ...
Quick apply
Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality ... Proficient in Utilization Review process including benefit interpretation, contract language ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
... to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed ... process including benefit interpretation, contract language, medical and policy review. • ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
... to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed ... process including benefit interpretation, contract language, medical and policy review. • ...
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 ...
Licensed Clinical Social Worker (LCSW)
Fuquay Varina, NC · Remote
$115K - $120K/yr
... case management skills * Familiarity with telehealth platforms and electronic health records Benefits * 2 weeks PTO * Health Insurance * 401K Plan with 3% Company Match Step into a weekday remote ...
Licensed Clinical Social Worker (LCSW)
Fuquay Varina, NC · Remote
$115K - $120K/yr
... case management skills * Familiarity with telehealth platforms and electronic health records Benefits * 2 weeks PTO * Health Insurance * 401K Plan with 3% Company Match Step into a weekday remote ...
TASC Care Manager
Garner, NC · Remote
$42K - $45K/yr
... case management and service coordination within the TASC (Treatment Accountability for Safer ... Proficiency in using electronic health record systems and remote collaboration tools (i.e., Teams ...
Quick apply
TASC Care Manager
Garner, NC · Remote
$42K - $45K/yr
... case management and service coordination within the TASC (Treatment Accountability for Safer ... Proficiency in using electronic health record systems and remote collaboration tools (i.e., Teams ...
Remote Case Management Processor information
See Raleigh, NC salary details
$14.02 - $16.51
6% of jobs
$18.83 is the 25th percentile. Wages below this are outliers.
$16.51 - $18.99
20% of jobs
The median wage is $21.32 / hr.
$18.99 - $21.48
25% of jobs
$21.48 - $23.96
21% of jobs
$24.58 is the 75th percentile. Wages above this are outliers.
$23.96 - $26.45
9% of jobs
$26.45 - $28.93
5% of jobs
$28.93 - $31.42
4% of jobs
$31.42 - $33.90
3% of jobs
$33.90 - $36.39
2% of jobs
$36.39 - $38.88
2% of jobs
$38.88 - $41.36
1% of jobs
$14
$24
$41
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What is the difference between Remote Case Management Processor vs Remote Claims Processor?
| Aspect | Remote Case Management Processor | Remote Claims Processor |
|---|---|---|
| Credentials | Typically requires case management certifications or healthcare-related credentials | Often requires insurance or claims processing certifications |
| Work Environment | Healthcare or social services settings, remote or office-based | Insurance companies, healthcare providers, remote or office-based |
| Industry Usage | Healthcare, social services, insurance | Insurance, healthcare, financial services |
| Job Focus | Managing patient or client cases, coordinating services | Processing insurance claims, verifying coverage |
While both roles involve processing information remotely, the Remote Case Management Processor focuses on managing client cases and coordinating services, often in healthcare or social services. In contrast, the Remote Claims Processor primarily handles insurance claims, verifying coverage and processing payments. Understanding these differences helps job seekers identify the right role based on their credentials and career interests.

Full-time
Medical, Dental, Vision, Retirement, PTO
This job post has expired 1 day ago. Applications are no longer accepted.
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 client’s 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 patient’s 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 Valeris’ values as the driving force behind the team’s 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