Senior Remote Specialty Reimbursement Case Manager

Randstad USA; United States; Remote; USD 23,000 - 32,000; Full time

Benefits offered by this job

Equipment provided

Job summary

Randstad USA is seeking an experienced Case Manager for a fully remote specialty pharmacy support role. This advanced position requires autonomy, deep industry knowledge, and the ability to manage the entire lifecycle of patient cases from initial contact to final resolution.

You will resolve complex insurance and access problems, handle prior authorizations and appeals, research funding options, and mediate difficult payer issues to ensure patient outcomes.

Qualifications

• High School Diploma or equivalent required; additional education preferred.
• Must have direct experience in Benefit Investigations, Medicare/Medicaid, or insurance company work within the last 3 years.
• Proficient with MS Office and video conferencing tools; strong typing (40 WPM).
• Must be able to work independently within established procedures and meet daily/weekly metrics.

Responsibilities

• Case Management: monitor accounts from initial contact through final approval or denial.
• Insurance & Benefit Verification: contact insurance companies to verify coverage and benefits.
• Payer Mediation: resolve complex payer and specialty pharmacy issues.
• Alternative Funding Research: explore funding options and foundations for patient eligibility.
• Patient & Pharmacy Coordination: verify coverage, confirm approvals/denials, coordinate with dispensing pharmacies.
• Patient Support: resolve complex patient inquiries about assistance status.
• Documentation & Compliance: transcribe case details into software and document Adverse Events.

Skills

Typing 40 WPM

Microsoft Office

Video conferencing

Education

High School Diploma or equivalent

Tools

Microsoft Office

Microsoft Teams

Zoom

Job description

Randstad USA is seeking an experienced Case Manager for a fully remote specialty pharmacy support role. This advanced position requires autonomy, deep industry knowledge, and the ability to manage the entire lifecycle of patient cases from initial contact to final resolution.

You will resolve complex insurance and access problems, handle prior authorizations and appeals, research funding options, and mediate difficult payer issues to ensure patient outcomes.