Case Manager

Ashfield Healthcare, LLC; Yardley (WA); Hybrid; USD 38,000 - 70,000; Full time

Benefits offered by this job

Competitive pay

Comprehensive benefits

401(k) with company match

Paid time off

Company holidays

Career advancement

Great Place to Work award

Job summary

Inizio Engage is seeking a Patient Access Specialist to manage assigned patient cases from referral through therapy initiation, ensuring timely and compliant progression.

You will conduct benefits investigations, determine coverage and patient financial responsibility, manage prior authorizations and appeals, and assist patients with enrollment in financial assistance programs while coordinating with payers, providers, and internal teams.

Qualifications

• Bachelor's degree or equivalent experience preferred.
• Experience in patient access, HUB services, reimbursement support, specialty pharmacy, or healthcare case management preferred.
• Working knowledge of benefits investigation, prior authorization, appeals, and patient assistance programs.
• Strong communication and interpersonal skills with a patient-focused approach.

Responsibilities

• Manage assigned patient cases from referral through therapy initiation, ensuring timely, accurate, and compliant case progression.
• Conduct benefits investigations electronically or by calling the insurance company to determine coverage information, prior authorization requirements, and patient financial responsibility.
• Manage the prior authorization and appeals process, including obtaining plan-specific criteria and requirements, initiating, submitting, and tracking requests, and following up with plans, patients, and HCPs as needed to ensure timely outcomes.
• Identify and facilitate patient enrollment in financial assistance programs, including copay and patient assistance programs.
• Support communications with patients, healthcare providers, payers, and specialty pharmacies as needed.
• Provide education on insurance coverage, access pathways, and next steps in the treatment journey when needed.
• Collaborate with internal teams and external partners to ensure timely therapy initiation and adherence to service level agreements.
• Document all case activity accurately within HUB systems in compliance with SOPs and regulatory requirements.
• Monitor case progress and elevate complex reimbursement issues as needed.
• Response to incoming calls from patients/caregivers and prescriber’s offices and addressing or routing calls as needed.
• Support leadership with tracking and resolving escalations.
• Support quality initiatives, audits, and continuous process improvement efforts.
• Ensure compliance with HIPAA, privacy, and regulatory standards at all times.

Skills

Strong communication

Interpersonal skills

CRM systems

Microsoft Office

Education

Bachelor's degree or equivalent experience

Tools

CRM systems

Microsoft Office

Job description

Why You’ll Love Working Here

• Competitive pay that recognizes your experience, expertise, and impact
• Comprehensive benefits including medical, dental, and vision coverage; accrued paid time off; 401(k) with company match; disability and life insurance; and paid maternity and paternity leave
• Company-paid holidays so you can rest, recharge, and focus on what matters most
• Recognition programs, contests, and awards that celebrate your contributions
• Continuous growth opportunities through learning, leadership development, and career advancement support
• A collaborative culture where your ideas are valued and your work makes a difference
• We’re also proud to be recognized for creating an exceptional employee experience: Best Place to Work in BioPharma — 2022, 2023, 2025 Certified Great Place to Work® — 2021, 2023, 2025, 2026
• Learn more: https://www.greatplacetowork.com/certified-company/7003732

What will you be doing?

• Manage assigned patient cases from referral through therapy initiation, ensuring timely, accurate, and compliant case progression
• Conduct benefits investigations electronically or by calling the insurance company to determine coverage information, prior authorization requirements, and patient financial responsibility
• Manage the prior authorization and appeals process, including obtaining plan-specific criteria and requirements, initiating, submitting, and tracking requests, and following up with plans, patients, and HCPs as needed to ensure timely outcomes.
• Identify and facilitate patient enrollment in financial assistance programs, including copay and patient assistance programs
• Support communications with patients, healthcare providers, payers, and specialty pharmacies as needed
• Provide education on insurance coverage, access pathways, and next steps in the treatment journey when needed
• Collaborate with internal teams and external partners to ensure timely therapy initiation and adherence to service level agreements
• Document all case activity accurately within HUB systems in compliance with SOPs and regulatory requirements
• Monitor case progress and elevate complex reimbursement issues as needed
• Response to incoming calls from patients/caregivers and prescriber’s offices and addressing or routing calls as needed
• Support leadership with tracking and resolving escalations
• Support quality initiatives, audits, and continuous process improvement efforts
• Ensure compliance with HIPAA, privacy, and regulatory standards at all times

What do you need for this position?

• Bachelor’s Degree or equivalent experience preferred
• Experience in patient access, HUB services, reimbursement support, specialty pharmacy, or healthcare case management preferred
• Working knowledge of benefits investigation, prior authorization, appeals, and patient assistance programs
• Strong communication and interpersonal skills with a patient-focused approach
• Ability to manage a high volume of cases in a fast-paced environment while meeting service level expectations
• Proficiency with CRM systems and Microsoft Office applications
• Strong organizational, analytical, and problem-solving skills
• Ability to prioritize workload and manage multiple tasks effectively

The base pay range for this position is $38K – $70K per year. The final compensation offered to a successful candidate will be determined by factors such as experience, skills, internal equity, and business needs.

About Inizio Engage

Inizio Engage is a strategic, commercial, and creative engagement partner that specializes in healthcare. Our passionate, global workforce augments local expertise and diverse mix of skills with data, science, and technology to deliver bespoke engagement solutions that help clients reimagine how they engage with their patients, payers, people, and providers to improve treatment outcomes. Our mission is to partner with our clients, improving lives by helping healthcare professionals and patients get the medicines, knowledge and support they need. We believe in our values: We empower everyone/We rise to the challenge/We work as one/We ask what if/We do the right thing, and we will ask you how your personal values align to them.

To learn more about Inizio Engage, visit us at: https://inizio.com/

Equal Opportunity & Inclusion

Inizio Engage is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, gender, gender identity or expression, genetic information, marital status, medical condition (including pregnancy, childbirth, or related conditions), mental or physical disability, national origin, protected family care or medical leave status, race, religion (including beliefs and practices or the absence thereof), sexual orientation, military or veteran status, or any other characteristic protected by applicable federal, state, or local law. Inizio Engage is committed to providing reasonable accommodations in accordance with applicable law. Inizio Engage complies with applicable fair chance hiring laws and will consider qualified applicants regardless of criminal history. Where permitted by applicable law, employment offers may be contingent upon the successful completion of a background check. Any information obtained from a background check will be considered in relation to the requirements of the relevant position, consistent with applicable law.

Candidate Use of Artificial Intelligence in Interviews

As part of our commitment to a fair and equitable hiring process, candidates are expected to complete all interview activities without the use of artificial intelligence tools or external assistance unless such assistance is authorized in advance by Inizio Engage or otherwise required in accordance with applicable law. This includes, but is not limited to, using generative artificial intelligence platforms to produce, edit, or guide responses in real time. Candidates may be asked to confirm compliance with this policy. Any violation of this policy may result in disqualification from consideration of employment. Candidates may submit requests for reasonable accommodation in accordance with applicable law to the Inizio Engage Talent Acquisition team.

Inizio Engage is a strategic, commercial and creative engagement partner that specializes in healthcare. Our passionate, global workforce augments local expertise and diverse mix of skills with data, science and technology to deliver bespoke engagement solutions that help clients reimagine how they engage with their patients, payers, people and providers to improve treatment outcomes. That’s why at Inizio Engage we’ve brought together a group of more than 7,000 experts, working in more than 20 countries. A passionate, diverse team with global reach and local knowledge. Together, we partner with our clients to challenge conventional thinking to empower people to make better health decisions and enhance treatment outcomes across the globe.