Case Manager

🔥 5 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $21 - $22 / hour

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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TEKsystems

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1983

💼 Consulting

🎯 Recruiter

🏢 Enterprise

Consulting • Recruitment • Enterprise

TEKsystems is a global IT and business services firm that provides technology consulting, talent solutions, managed services and workforce recruitment to enterprise clients. The company delivers cloud, digital and data services (including AI/ML and automation), application innovation, Agile/DevOps transformation, technology operations and digital experience work, and operates large-scale talent and managed service programs. TEKsystems works across industries (financial services, healthcare, public sector, telecommunications, retail/manufacturing, energy and more), maintains technology partnerships with major cloud and software providers, and reports more than $7B in annual revenue and 100+ locations worldwide.

📋 Description

• Serve as a subject matter expert on benefit coordination and patient support resources • Handle inbound and outbound telephony and email communications with patients, physician offices, and specialty pharmacies • Explain eligibility requirements, program enrollment processes, and affordability support • Establish and maintain professional relationships with healthcare providers and patients • Serve as the primary point of contact for healthcare providers regarding program offerings and patient cases • Navigate benefits across private/commercial plans and government programs, including Medicare, Medicaid, VA, and DoD, with focus on Medicare Part B • Ask targeted questions to navigate payer challenges and achieve positive outcomes • Liaise between client contacts, internal program teams, and field representatives • Maintain accurate, compliant records according to applicable standards, regulations, and program requirements • Follow SOPs, call guides, and program materials; escalate complex or atypical cases • Collaborate daily with Program Management and internal stakeholders regarding patient status, prescriber feedback, coordination challenges, and program effectiveness • Deliver high-quality customer service and advocate for the brand and program • Apply disease-state understanding to support patient needs • Proactively assess situations and intervene to ensure timely therapy access • Protect confidential patient and provider information • Support a positive, collaborative team culture • Use appropriate resources and channels for conflict resolution • Complete required training and compliance modules on time • Perform additional tasks and special projects as assigned

🎯 Requirements

• 2+ years of experience in pharmaceutical benefit processes • 2+ years of experience in HUB or patient services roles • Previous experience working in a contact center environment • Hands-on experience with pharmaceutical benefit processes across multiple payer types • Experience with medical benefit processes, including Medicare, Medicaid, VA, and DoD, with expertise in Medicare Part B • Proven ability to manage inbound and outbound calls in a high-volume, service-oriented setting • Demonstrated experience providing phone-based support and customer service • Experience with insurance verification or similar benefit investigation activities • Ability to follow detailed SOPs, call guides, and program materials consistently • Strong organizational skills and ability to maintain accurate and compliant documentation • High level of professionalism, ethics, and respect for confidentiality and privacy requirements • Ability to work collaboratively with program management and cross-functional teams in a remote environment • Experience supporting patient services or HUB programs for specialty therapies • Familiarity with affordability programs, patient assistance programs, and reimbursement support • Comfort navigating payer policies, coverage criteria, prior authorization, and appeals processes • Strong problem-solving skills for complex situations • Ability to build rapport with patients and healthcare providers through empathetic, clear communication • Demonstrated conflict resolution and de-escalation skills • Positive attitude and resilience in a fast-paced, metrics-driven environment • Willingness to take on additional tasks or projects as needed

🏖️ Benefits

• Medical, dental & vision • Critical Illness, Accident, and Hospital coverage • 401(k) Retirement Plan with pre-tax and Roth post-tax contributions • Life Insurance, including voluntary Life & AD&D for the employee and dependents • Short- and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

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