Case Manager

Randstad USA; Irving (TX); On-site; USD 26,000 - 28,000; Full time

Job summary

Randstad USA is seeking a Case Manager to oversee end-to-end onboarding and qualification for specialty pharmaceutical therapies, focusing on benefits investigations, enrollments, and navigating complex payer landscapes to ensure fast delivery of medications.

You will work with patients and care teams to verify coverage, explain costs, and remove administrative hurdles to ensure timely access to therapies. The role requires 2–4 years of industry experience and healthcare admin familiarity.

Qualifications

• 2–4 years of high-touch patient/customer-facing experience.
• Healthcare Hub or Patient Support Services admin experience preferred.
• Strong knowledge of Medicare/Medicaid and commercial reimbursement.

Responsibilities

• Handle inbound and outbound calls to resolve issues on one call.
• Manage care pathway with urgency, verify benefits, track fulfillment.
• Assist with prior authorization and medical appeal requirements.
• Review intake forms and enrollment docs to update the tracking system.
• Explain insurance coverage, out-of-pocket costs, and assistance options.

Skills

Medicare/Medicaid

Prior authorization

Benefits Verification

Handling Confidential Information

Customer Service

HIPAA

Pharmaceutical industry

Education

High School

Job description

Our client is hiring Case Manager to lead the end-to-end onboarding and qualification process for specialty pharmaceutical therapies. This high-touch role is perfect for a healthcare navigation expert who can seamlessly execute benefits investigations, process enrollments, and master complex payer landscapes. Your mission? To eliminate administrative roadblocks and ensure patients receive their critical medications without delay.

salary: $19 - $20 per hour

shift: First

work hours: 7 AM - 8 PM

education: High School

Responsibilities

Manage the end-to-end patient onboarding and qualification process for specialty pharmaceutical therapies. This high-touch role focuses on executing comprehensive benefits investigations, processing enrollments, and navigating complex payer landscapes to ensure fast, unhindered medication delivery.

Key Responsibilities:

• Handle inbound and outbound calls from patients, insurance carriers, and healthcare provider offices to facilitate one-call issue resolution.
• Manage the complete care pathway with urgency, conducting detailed benefit verifications and tracking medication fulfillment.
• Investigate insurance plan rules and assist with securing complex prior authorization and medical appeal requirements.
• Scrutinize medical intake forms and enrollment documentation thoroughly to add new information into the tracking database.
• Help patients and caregivers clearly interpret their specific insurance plan coverage, out-of-pocket costs, and external assistance options.

Requirements:

• 2 to 4 years of industry experience featuring high-touch customer or patient-facing interactions.
• Prior administrative experience in a healthcare Hub setting or Patient Support Services environment is highly preferred.
• Strong knowledge of Medicare (Parts A, B, C, D), Medicaid, and commercial medical/pharmacy reimbursement landscapes.

Skills

• Medicare/Medicaid
• Prior authorization
• Benefits Verification (1 year of experience is required)
• Handling Confidential Information
• Customer Service
• HIPAA (1 year of experience is required)
• Pharmaceutical industry

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [e-mail].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Experience

• Experienced
• 2 years

Education

• High School (required)