Executive Case Manager (Remote)

Valeris; Florida; On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

401(k) with company match

Paid time off (PTO)

Opportunities for advancement

Job summary

Valeris is seeking an Executive Case Manager to work remotely, aiding patients in accessing medications and navigating healthcare processes. The role requires building relationships with patients and healthcare providers while ensuring compliance with relevant regulations.

This position calls for a bachelor’s degree and significant experience in healthcare access delivery. Benefits include medical plans, a 401(k) matching contribution, and opportunities for career advancement.

Qualifications

• Completion of a Bachelor’s degree (or higher) required.
• Minimum two years of experience in healthcare access delivery or management preferred.
• 5–10 years of experience in related fields can substitute for a degree.

Responsibilities

• Build trusted relationships with patients and prescribers.
• Provide personalized case management to patients.
• Ensure all SOPs and corporate policies are followed.

Skills

Healthcare administration knowledge

Insurance reimbursement expertise

Effective communication skills

Critical thinking

Organization and attention to detail

Education

Bachelor’s degree in healthcare administration or related field

Job description

About Valeris

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions spanning 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, building 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. The company is headquartered in Morrisville, North Carolina, and Jeffersonville, Indiana.

Job Overview

This is a remote role; candidates must reside in the state of Florida. As an Executive Case Manager you will make a difference in the lives of our patients each day, providing exceptional support and navigating the complex process of medication access.

Key Responsibilities

• Relationship Management
  • Builds trusted relationships with patients, prescribers, and relevant client stakeholders through proactive communication, timely execution of deliverables, and relentless passion for helping patients.
  • Manages all relationships in accordance with relevant laws, regulations, program‑specific operating procedures, and industry standards, including HIPAA and insurance guidelines.
• Inbound Call Management
  • Manages inbound calls as directed by the program‑approved FAQs.
  • Triage patients to internal or external resources as appropriate.
• Personalized Case Management
  • Provides personalized case management to patients and HCPs, including outbound communication to HCPs, specialty pharmacies, and patients to communicate benefit coverage and advance the access journey.
  • Leverages electronic tools to identify benefits and payer coverage, completing manual benefit investigations when necessary.
  • Identifies and communicates patient plan benefit coverage, including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
  • Serves as a subject‑matter expert to the internal team as required.
  • Coordinates nurse education, supports adherence services, and identifies peer support resources for patients.
  • Proactively communicates needs for reverification of prior authorization or re‑enrollment.
  • Identifies and reports adverse events, product complaints, special situation reports, and medical inquiries per program operating procedures.
  • Documents all activities in the PharmaCord Lynk system, maintaining detailed reimbursement records and generating reports to identify trends and improvement opportunities.
• Compliance and SOP Adherence
  • Ensures all SOPs and corporate policies are followed consistently.
  • Performs additional tasks or projects as assigned.

Qualifications

• Completion of a Bachelor’s degree (or higher) required. A degree in healthcare administration, social science, or a related field is strongly preferred.
• Minimum two years of experience in healthcare access delivery or management strongly preferred.
• 5–10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education will be considered in lieu of a degree.
• Relevant certifications (e.g., PACS, CHES, CCM) and five or more consecutive years of experience in a related field considered.
• Strong understanding of medical terminology, coding systems (ICD‑10, CPT, HCPCS), and insurance processes.
• 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, with the ability to interact professionally with diverse stakeholders.
• Demonstrated ability to think critically and resolve issues.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
• Bi‑lingual skills are a plus.
• Remote work eligibility is subject to meeting all work‑from‑home criteria based on business need.

Physical Demands & Work Environment

• Regularly required to talk or hear; frequently required to sit for long periods, type using hands, and reach with arms. Preferred candidate can type at least 35 words per minute with 97% accuracy.
• Minimal flexibility to travel as needed preferred.
• Job operates in a professional office environment using standard equipment such as computers, phones, and photocopiers.

Benefits

• Medical, dental, and vision plans, including HSA‑ and FSA‑eligible options, with Valeris contributing toward premium costs.
• Telehealth support 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.
• 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 creates an inclusive workplace.
• A mission‑driven culture where your work makes a meaningful impact.

Equal Opportunity

At Valeris, we celebrate and support difference and thrive on diversity for the benefit of our employees, products, and community. Valeris is proud to be an equal‑opportunity employer.

Application Process Notes

Any offer of employment is contingent upon the successful completion of a background check and, where applicable, a drug screen in accordance with company standards. This job description is not an exhaustive list of all duties, responsibilities, or activities associated with the position; responsibilities and tasks may be modified at any time, with or without notice.