Case Manager

Valeris, Inc.; Montgomery (AL); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Medical, dental, vision

HSA/FSA options

401(k) match

Paid time off

Holidays

Career growth

Job summary

Valeris, Inc. is seeking a Case Manager to provide inbound/outbound support, coordinating patient benefits, orders, and appointments with payers, patients, and providers.

You’ll serve as a dedicated contact for stakeholders, ensuring a smooth patient journey while navigating payer policies and program guidelines. Ideal candidates will have a degree and reimbursement/insurance experience, strong communication skills, and proficiency with Microsoft Office.

Qualifications

• Associate or bachelor’s degree; 2 years of reimbursement/insurance experience preferred.
• Call Center or customer service experience required.
• Excellent written and oral communication.
• Strong knowledge of prior authorization and appeals.
• Familiar with Medicare/Medicaid and payer types.

Responsibilities

• Coordinate benefits and patient support services.
• Act as liaison with payers, providers, and patients.
• Ensure accurate patient information and program enrollment.
• Maintain records per SOPs and guidelines.
• Provide exceptional customer service to stakeholders.

Skills

Case management

Payer outreach

Customer service

Medicare knowledge

Microsoft Office

Education

Associate or Bachelor's degree

Job description

About Valeris

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need.

Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.

Job Overview

As a Case Manager, you provide inbound and outbound phone support and may serve as the primary contact for payers, patients, caregivers, specialty pharmacies, site of care centers, specialty distributors, pharmacy compounders, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient benefits, product orders and appointment coordination with the purpose of facilitating the overall patient journey. This includes utilizing services offered through the Patient Support Program on behalf of a manufacturer (client). The primary function is to provide unparalleled customer service to key internal and external stakeholders as a dedicated contact by coordinating resources, exchanging information, and ensuring appropriate.

Key Responsibilities

• Case Managers may be regionally aligned and will serve as an expert on all aspects of benefit coordination, and other forms of available support and will be responsible for handling healthcare provider and/or patient interactions
• May serve as an advocate to patients regarding eligibility requirements, program enrollment, affordability support, and general access for prescribed therapy
• Establishes relationships, develop trust, and maintain rapport with healthcare providers and/or patients
• Serves as point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient
• Strong working knowledge and ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD); with expertise in Medicare Part B
• Navigates through payer challenges by asking appropriate questions to obtain the necessary result
• Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
• Maintains records in accordance with applicable standards and regulations to the programs/promotion
• Follows program guidelines and escalates complex cases according to SOPs, Call Guides, and other program materials.
• Liaison between Program Management, other internal stakeholders, and healthcare providers
• Provides unparalleled customer service, with attention to detail, while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commits to the appropriate use of resources
• Works with all levels of Program Management on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction, coordination challenges and program effectiveness
• Understands the nature of the disease states of patients of the program
• Assesses situations to act and intervene where needed to obtain a timely resultMaintains a high level of ethical and professional conduct regarding confidentiality and privacy
• Helps maintain team morale by consistently demonstrating a positive attitude and strong work ethics
• Utilizes the necessary resources for conflict resolution as needed.
• Utilize Valeris’ values as the driving force behind the team’s success
• On time adherence to training deadlines for all corporate policies and procedures
• Ensure all SOPs are followed with consistency
• Perform additional tasks or projects as assigned

Qualifications

• Associate or bachelor’s degree and 2 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred, or in lieu of a degree, a High School diploma or equivalent with 5 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing
• Call Center/HUB or customer service experience with progressive levels of responsibility within a service driven environment required
• Excellent communication skills; orally and in writing
• Strong working knowledge of prior authorization and appeals is required
• Strong knowledge of medical and pharmacy insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related benefit coordination experience
• Excellent problem-solving and decision‑making skills required
• Attention to detail and committed follow through in communication with patients, providers, and internal/external stakeholders
• Strong organizational skills for fast paced environment
• Ability to adapt to change while maintaining Program standards
• Strong team players are willing to jump in and help other team members when needed.
• Empathetic listening skills to interact effectively with patients and providers.
• Punctual, reliable with strong attendance record
• Strong customer service experience and skills
• Proficient with Microsoft products (Excel, Word, PowerPoint, and Outlook)

Physical Demands & Work Environment

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy. Although very minimal, flexibility to travel as needed is preferred. This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.

Why Work for Valeris?

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
• Additional health support, including telehealth and Employee Assistance Program (EAP) services
• Company match on Health Savings Account contributions
• Free Basic Life and AD&D coverage equal to your 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% you contribute, with immediate vesting
• Paid Time Off (PTO) and Sick Leave to support work-life balance
• Team members receive nine paid holidays plus two floating holidays
• Opportunities for advancement in a company that supports personal and professional growth
• A challenging, stimulating work environment that encourages new ideas
• Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
• A mission‑driven, inclusive culture where your work makes a meaningful impact

Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards.

Our Commitment to Equal Opportunity

At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.

Purpose and Vision

A Name With Purpose. Inspired by those who work each day to transform access and enhance lives, our name emerges from the root valor: to be bold, brave, determined, be well, have worth. It speaks to integrity, simplicity, strength, and principled action. Valeris merges this with vision and an intention to redefine value at every step in the patient journey. We honor the science. We unlock the value. We do it with vision. We are Valeris. Purpose: Valeris represents measurable business impact through healthcare innovation that transforms lives. We combine cutting‑edge technology with healthcare expertise to tackle challenges in access, affordability, and quality of care. Success means improving patient outcomes - everything we do is anchored in the value of improving human lives.