Care Coordination Case Manager – Insurance Access

ConnectiveRx; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 61,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

401(k) plan

Paid time off

Holidays

Job summary

ConnectiveRx is seeking a Benefits Investigation Specialist to help ensure access to medications by working with medical insurers and pharmacy benefit managers. The role focuses on identifying coverage options and assisting patients with approvals, denials, and appeals as needed.

This position emphasizes education for patients and providers on insurance requirements, along with collaboration across pharma reps, doctors, and insurers to optimize coverage timelines and patient outcomes.

Qualifications

• Bachelor’s Degree in Health Care, Social Work, Nursing, or related area.
• Minimum of three years of health care insurance benefits experience.
• Experience with case management, utilization review, or patient advocacy is preferred.

Responsibilities

• Lead care coordination within an assigned territory, balancing patient and physician needs with program constraints.
• Coordinate information exchange between patients, families, providers, and insurers.
• Assist with insurance approvals/denials and Copay/Patient Assistance applications.
• Educate patients and health care providers on insurance requirements and options.

Skills

Verbal communication

Written communication

Mediation

Problem solving

Spanish language (plus)

Education

Bachelor's Degree

Job description

ConnectiveRx is seeking a Benefits Investigation Specialist to help ensure access to medications by working with medical insurers and pharmacy benefit managers. The role focuses on identifying coverage options and assisting patients with approvals, denials, and appeals as needed.

This position emphasizes education for patients and providers on insurance requirements, along with collaboration across pharma reps, doctors, and insurers to optimize coverage timelines and patient outcomes.