Executive Case Manager

🔥 4 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

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Valeris

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💊 Pharmaceuticals

🏥 Healthcare

🤝 B2B

Pharmaceuticals • Healthcare • B2B

Valeris is a fully integrated life sciences commercialization partner formed by the merger of PharmaCord and Mercalis. The company provides comprehensive solutions across the healthcare value chain to help life sciences companies bring products to market and improve patient access and adherence. Valeris offers data and strategic insights, patient support and access programs, and healthcare provider engagement tools, serving over 500 life sciences customers and supporting millions of patients. Headquartered in Morrisville, North Carolina and Jeffersonville, Indiana, Valeris focuses on enabling commercialization and patient-centric services for pharmaceutical and life sciences organizations.

📋 Description

• Manage the patient journey from initiation to closure • Complete benefit investigations • Track prior authorizations and denial appeals • Assist patients and callers/stakeholders through resolution via email, inbound/outbound calls, and Lynk technology • Provide education on access and reimbursement support tools, program benefits, and eligibility • Advise healthcare providers, patients, and caregivers • Educate healthcare provider offices on payer processes and procedures • Build trusted relationships with patients, prescribers, and client stakeholders • Support inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals • Perform post-benefits-investigation calls explaining coverage options and next steps • Manage client and healthcare provider inquiries • Triage patients to internal or external resources • Provide personalized case management and communicate benefit coverage and access next steps • Identify prior authorization, appeal, tier exception, and formulary exclusion needs • Follow up with payers and healthcare providers on submissions and outcomes • Coordinate nurse teaching with nurse educators • Support adherence services and identify peer-support resources • Manage prior-authorization reverification and re-enrollment needs • Identify and report adverse events, product complaints, special situation reports, and medical inquiries • Document reimbursement activities, claims status, payments, and appeals in Lynk • Generate reports and analysis to identify trends and improvement opportunities • Follow program procedures, SOPs, corporate policies, and training deadlines • Perform additional assigned tasks and projects

🎯 Requirements

• Completion of Bachelor's degree or higher required; healthcare administration, social science, or similar fields strongly preferred • In lieu of a degree, five plus years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required • Two years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education required • Minimum two years of experience in healthcare access delivery or management strongly preferred • Other certifications and five or more consecutive years of relevant experience may be considered • Strong understanding of medical terminology and coding systems including ICD-10, CPT, and HCPCS • Knowledge of insurance processes • Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines • 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 • Ability to think critically and resolve issues • Bilingual skills are a plus • Remote work eligibility subject to work-from-home criteria and business need • Ability to type at least 35 words per minute with 97% accuracy preferred • Flexibility to travel as needed preferred • Successful completion of a background check and, depending on the position, a drug screen

🏖️ Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs • Telehealth and Employee Assistance Program (EAP) services • Company match on Health Savings Account contributions • Free Basic Life and AD&D coverage equal to 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% contributed, with immediate vesting • Paid Time Off (PTO) and Sick Leave • Nine paid holidays plus two floating holidays • Opportunities for advancement and personal and professional growth • Challenging, stimulating work environment encouraging new ideas • Inclusive workplace and mission-driven culture • Background check and, depending on the position, drug screen required as a condition of employment

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