Remote Case Manager: Patient Access & Authorization

prospectus management consultants; United States; On-site; USD 114,616,000 - 154,732,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Life Insurance

Disability

401(k) Match

Employee Ownership

Home Office

PTO

Holidays

Bereavement Leave

EAP

Savings Accounts

Job summary

PRO-spectus is seeking a Case Manager to oversee patient cases across the authorization, approval, and appeals journey. You will work with payors, providers, and patients to expedite access to care while securing payment channels and controlling out-of-pocket costs.

The role requires excellent communication, critical thinking, and the ability to navigate multiple time zones in a remote-friendly environment. A nutrition background and prior authorization experience are preferred.

Qualifications

• Strong written and oral communication for diverse stakeholders.
• Ability to coordinate multiple priorities and activities to meet goals.
• Independent management of caseload with time management skills.

Responsibilities

• Act as single point of contact among internal team, client, providers, payor, facility and patient.
• Support cases through approval/denial process with urgency and accuracy.
• Direct Payor Specialist Team and coordinate efforts for case accuracy and completeness.
• Identify trends impacting business processes and share with management.
• Prioritize client activities and follow up to ensure problems are solved.
• Manage ambiguity and design innovative client/payor solutions.
• Make sound independent decisions in urgent situations.
• Interpret clinical documentation for payor submission according to policy criteria.
• Partner with interdisciplinary team to champion clients and lifecycle of cases.

Skills

Communication

Multitasking

Independent case load

Critical thinking

Creative problem-solving

Follow-through

Calm under pressure

Professionalism

US healthcare knowledge

Policy interpretation

Education

Bachelor’s or Associate Degree

Job description

PRO-spectus is seeking a Case Manager to oversee patient cases across the authorization, approval, and appeals journey. You will work with payors, providers, and patients to expedite access to care while securing payment channels and controlling out-of-pocket costs.

The role requires excellent communication, critical thinking, and the ability to navigate multiple time zones in a remote-friendly environment. A nutrition background and prior authorization experience are preferred.