Remote Healthcare Case Manager — Access & Appeals

Openkrill; United States; À distance; USD 55 000 - 74 000; Plein temps

Avantages offerts par ce poste

Employee Ownership Program

Home office benefits

401(k) retirement plan with employer–M

Paid time off

Résumé du poste

PRO-spectus is seeking a Case Manager to oversee the authorization and appeal journey for patients and providers, expediting access to care while securing payment. You will interact with payors, facilities, and families to ensure timely approval and coverage.

The role requires strong communication, multitasking, and critical thinking. Experience with US healthcare payer systems and complex medical products is preferred. Remote-friendly and supports time zones.

Qualifications

• College degree preferred (Bachelor's or Associate)
• 4–6 years in healthcare and/or medical insurance with customer service.
• Experience maintaining detailed records of client interactions.
• Experience in office, hospital, clinic, or home health settings welcome.
• Experience developing or implementing new technologies a plus.
• Experience with complex medical products and insurance processes a plus.
• Experience writing Appeals preferred.

Responsabilités

• Act as single point of contact between internal team, clients, providers, payor, facility, and patient as needed.
• Support cases through approval/denial process with a sense of urgency while maintaining accuracy.
• Coordinate efforts among Payor, Reimbursement, Clinical teams and client sales/MSL.
• Identify trends impacting business processes and report to management.
• Prioritize client activities and follow up to resolve issues.
• Design innovative client and payor solutions while managing ambiguity.
• Make independent decisions in urgent and non-routine situations.
• Interpret clinical documentation for payor submission per medical policy criteria.
• Champion clients, patients, and customers across the case life cycle.
• Provide resources for financial assistance and transportation.
• Provide compassionate support to patients and caregivers.

Description du poste

PRO-spectus is seeking a Case Manager to oversee the authorization and appeal journey for patients and providers, expediting access to care while securing payment. You will interact with payors, facilities, and families to ensure timely approval and coverage.

The role requires strong communication, multitasking, and critical thinking. Experience with US healthcare payer systems and complex medical products is preferred. Remote-friendly and supports time zones.