This is a remote role. Candidates must reside in the state of Ohio. When you join the team as an ... Relationship Management * Builds trusted relationships with patients, prescribers, and appropriate ...
This is a remote role. Candidates must reside in the state of Ohio. When you join the team as an ... Relationship Management * Builds trusted relationships with patients, prescribers, and appropriate ...
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 ... Relationship Management * Builds trusted relationships with patients, prescribers, and appropriate ...
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 ... Relationship Management * Builds trusted relationships with patients, prescribers, and appropriate ...
... 30% remote. The patient members that they will be assessing are dual eligible Medicare/ Medicaid. There duties include; day-to-day operations of the High Risk Case Management functions to include ...
... 30% remote. The patient members that they will be assessing are dual eligible Medicare/ Medicaid. There duties include; day-to-day operations of the High Risk Case Management functions to include ...
Case Manager/Group Facilitator- Remote
Toledo, OH ยท On-site +1
$401K/yr
Conduct assessments to determine the needs of clients seeking behavioral health and addiction recovery services, and case management needs of clients seeking behavioral health and addiction recovery ...
Case Manager/Group Facilitator- Remote
Toledo, OH ยท On-site +1
$401K/yr
Conduct assessments to determine the needs of clients seeking behavioral health and addiction recovery services, and case management needs of clients seeking behavioral health and addiction recovery ...
Case Manager: Substance use disorder & Mental health (Full-time/Part-time - 1099)
Cincinnati, OH ยท On-site +1
$21 - $26/hr
... case management services to individuals with substance use disorders, including those with co ... The role is a remote, telehealth position Essential Duties and Responsibilities * Complete initial ...
Case Manager: Substance use disorder & Mental health (Full-time/Part-time - 1099)
Cincinnati, OH ยท On-site +1
$21 - $26/hr
... case management services to individuals with substance use disorders, including those with co ... The role is a remote, telehealth position Essential Duties and Responsibilities * Complete initial ...
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH ... Maintain strong attention to detail, organizational skills, and effective time management. Work ...
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH ... Maintain strong attention to detail, organizational skills, and effective time management. Work ...
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH) Pay ... Maintain strong attention to detail, organizational skills, and effective time management. Work ...
Quick apply
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH) Pay ... Maintain strong attention to detail, organizational skills, and effective time management. Work ...
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH ... Maintain strong attention to detail, organizational skills, and effective time management. Work ...
Quick apply
Case Manager
Columbus, OH ยท Remote
$27 - $33/hr
Remote, U.S.-based, from an approved work location (Must be within 100 miles of Columbus, OH ... Maintain strong attention to detail, organizational skills, and effective time management. Work ...
Care Management Lead, (RN OR LSW) - Akron - Remote
Akron, OH ยท On-site +1
$68K - $84K/yr
Manage the case conference process, facilitating case review as well as discussion of risk ... With flexible schedules, a remote-first culture, and a nationally recognized wellness program, our ...
Care Management Lead, (RN OR LSW) - Akron - Remote
Akron, OH ยท On-site +1
$68K - $84K/yr
Manage the case conference process, facilitating case review as well as discussion of risk ... With flexible schedules, a remote-first culture, and a nationally recognized wellness program, our ...
This is a REMOTE, work from home position*** The Case Manager is responsible for all customer service functions and quality control of the final investigative product, also serving as the liaison ...
This is a REMOTE, work from home position*** The Case Manager is responsible for all customer service functions and quality control of the final investigative product, also serving as the liaison ...
This is a REMOTE, work from home position*** The Case Manager is responsible for all customer service functions and quality control of the final investigative product, also serving as the liaison ...
This is a REMOTE, work from home position*** The Case Manager is responsible for all customer service functions and quality control of the final investigative product, also serving as the liaison ...
This is a REMOTE, work from home position*** The Case Manager is responsible for all customer service functions and quality control of the final investigative product, also serving as the liaison ...
This is a REMOTE, work from home position*** The Case Manager is responsible for all customer service functions and quality control of the final investigative product, also serving as the liaison ...
Senior Business Immigration Case Manager
Cincinnati, OH ยท Remote
$65K - $105K/yr
... management of enterprise client accounts, or multiple mid-market accounts. In this role, you will ... 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
... management of enterprise client accounts, or multiple mid-market accounts. In this role, you will ... 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
Experience in IBM FileNet Content Management (CPE, workflows, integrations, IBM Case Manager or IBM ... 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
Experience in IBM FileNet Content Management (CPE, workflows, integrations, IBM Case Manager or IBM ... 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
Experience in IBM FileNet Content Management (CPE, workflows, integrations, IBM Case Manager or IBM ... 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
Experience in IBM FileNet Content Management (CPE, workflows, integrations, IBM Case Manager or IBM ... 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
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 ...
Field Case Manager - Vocational
Cincinnati, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Toledo, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Toledo, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Toledo, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Toledo, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
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 ...
Field Case Manager - Vocational
Dublin, OH ยท On-site +1
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 ...
Remote Disaster Case Management information
What is the difference between Remote Disaster Case Management vs Remote Emergency Social Services Coordinator?
| Aspect | Remote Disaster Case Management | Remote Emergency Social Services Coordinator |
|---|---|---|
| Required Credentials | Case management certification, social work degree often preferred | Social work or counseling background, certifications may vary |
| Work Environment | Remote, often during disaster response periods | Remote, during emergency response and community outreach |
| Employer & Industry Usage | Nonprofits, government agencies, disaster relief organizations | Government agencies, nonprofits, emergency response teams |
| Search & Comparison Intent | Understanding roles in disaster recovery, case management tasks | Coordination of emergency services, community support roles |
Remote Disaster Case Management involves coordinating services for disaster-affected individuals, focusing on recovery and resource allocation. Remote Emergency Social Services Coordinators handle community outreach and emergency support, often during crises. While both roles require social work skills and operate remotely, their focus areas and employer types differ slightly, making this comparison useful for those exploring careers in disaster and emergency response.
What are the main challenges faced by remote disaster case managers, and how can they effectively overcome them?
What are the key skills and qualifications needed to thrive as a remote disaster case manager?
What is remote disaster case management?
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Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 6 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