Case Manager

JOB DESCRIPTION

 
Job Description: The purpose of this position is to help patients get access to the medications and therapies that they need.
About AssistRx: Voted Top Work Places in Orlando 3 years in a row, AssistRx understands that the key to success is our fantastic team members. AssistRx has engineered the perfect blend of technology and talent to deliver best in class results. We believe that access to specialty therapies transforms lives and is achieved through the powerful combination of our people and technology. Want to know more? Follow us on  to find out how our team members are #TransformingLives.
Why Choose AssistRx:
 
 Work Hard, Play Hard: Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary. Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
 
 Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
 
 Flexible Culture: Many associates earn the opportunity to work a hybrid schedule after 120 days after training. Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
 
 Career Growth: We prioritize a “promote from within mentality”. We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
 
 Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
 
 Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible. Tell your friends about us! If hired, receive a $750 referral bonus! 
 
A Day in the Life as a Case Manager:
This role works directly with healthcare providers & insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. The Case Manager will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the appeals process to access medications.
 
Ensure cases move through the process as required in compliance with company requirements and the organization's defined standards and procedures; in a manner that provides the best level of service and quality
 
Conduct benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers
 
 Verify patient specific benefits and document specifics including coverage, cost share and access/provider options
 
Identify any coverage restrictions and details on how to expedite patient access
 
 Document and initiate prior authorization process and claims appeals
 
Report any reimbursement trends or delays in coverage to management
 
 Act as a liaison for field representatives, health care providers and patients
 
Requirements
Qualifications to be a Case Manager:
 
In-depth understanding and experience with Major Medical & Pharmacy Benefit Coverage 
 
 2 to 3 years of benefit investigation involving the analysis and interpretation of insurance coverage
 
 2 to 3 years of experience interacting with healthcare providers in regard to health insurance plan requirements
 
Excellent verbal communication skills and grammar
 
 Salesforce system experience preferred
 
Benefits
Want to learn more about what employee benefits AssistRx offers? Here are some additional benefits that our employees enjoy! 
 
Medical, dental, vision, life, & short-term disability insurance
 
Teledoc services for those enrolled in medical insurance
 
Supportive, progressive, fast-paced environment
 
Competitive pay structure
 
Matching 401(k) with immediate vesting
 
Legal insurance 
 
 
Wondering how we recognize our employees for delivering best in class results? Here are some of the awards that our employees receive throughout the year!
 
 #TransformingLives Honor: This quarterly award program is a peer to peer honor that recognizes and highlights some of the amazing ways that our team members are transforming lives for patients on a daily basis.
 
 Values Award: This quarterly award program recognizes individuals who exhibit one, or many, of our core company values; Excellence, Winning, Respect, Inspiration, and Teamwork.
 
 Vision Award: This annual award program recognizes an individual who has gone above and beyond to support the AssistRx vision to transform lives through access to therapy.
 
AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.
All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.
AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.