WFH Case Manager

TEKsystems; Houston (TX); À distance; USD 26 000 - 37 000; Plein temps

Avantages offerts par ce poste

Medical

Dental & Vision

401(k) Plan

Short/Long-term Disability

Life Insurance

HSA

Transportation benefits

Paid Time Off

Résumé du poste

TEKsystems is seeking an Executive Case Manager to deliver reimbursement expertise and case management for patients, caregivers and healthcare professionals. The role emphasizes education on access tools, payor processes and program eligibility, while maintaining HIPAA compliance and strong client relationships.

The position involves outbound/inbound calls, case management, and collaboration with HCP offices to navigate coverage options effectively across a remote work setup.

Qualifications

• Bachelor's degree or higher required.
• Degree in healthcare administration or similar preferred.
• Minimum two years in healthcare access delivery or management preferred.
• 5–10 years in insurance reimbursement or patient access may substitute for degree.
• Certifications such as PACS, CHES or CCM considered.
• Strong understanding of ICD-10, CPT, HCPCS and insurance processes.

Responsabilités

• Builds trusted relationships with patients, prescribers and client stakeholders regarding reimbursement inquiries.
• Adheres to HIPAA, insurance guidelines and program procedures.
• Supports inbound/outbound calls to patients, caregivers, pharmacies and healthcare professionals.
• Explains coverage options and next steps in the access journey.
• Triages patient inquiries and refers to resources as appropriate.
• Provides personalized case management to patients and HCPs.
• Maintains compliant communications with client field teams.

Connaissances

Healthcare access

Patient education

Insurance processes

HIPAA compliance

Medical terminology

Formation

Bachelor's degree

Healthcare administration degree

Description du poste

Description

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The Executive Case Manager responsibilities include education on the access and reimbursement support tools available from Valeris and participating program, advising HCPs and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on Payor processes and procedures.

Key Responsibilities:

• Builds trusted relationships with patients, prescribers, and appropriate client stakeholders regarding reimbursement inquiries and challenges through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients.

• Manages all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines.

• Managed through call/contact center structure, this role supports inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.

• Performs post Benefits Investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey.

• Manages all client inquiries as appropriate, such as case specific statuses.

• Manages HCP inquiries, as applicable, pursuant to business rules.

• All communications with the clients field teams will remain compliant and adhere to ways of working protocols outlined between Valeris and the client teams. 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

Additional Skills & Qualifications

• Completion of Bachelor's degree (or higher) required

• A degree in healthcare administration, social science or similar related fields is strongly preferred.

• Minimum two years of experience in healthcare access delivery or management is strongly preferred.

• 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree.

• Will consider other certifications and five or more consecutive years of experience in relevant field. Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager).

• Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.

Job Type & Location

This is a Contract position based out of Houston, TX.

Pay and Benefits

The pay range for this position is $23.00 - $23.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Application Deadline

This position is anticipated to close on Nov 13, 2026.

Workplace Type

This is a fully remote position.

About TEKsystems

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

About TEKsystems and TEKsystems Global Services

Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

San Francisco Fair Chance Ordinance

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI)

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.