Job Description

CASE MANAGER

Location: Onsite - Cary, NC

COMPENSATION & SCHEDULE

• Pay: $24.00/hour

• Schedule: Monday–Friday (8 AM–8 PM shifts: 8–5, 10–7, 11–8)

• Employment Type: W2 contract with possible conversion to FTE

ROLE IMPACT: The Case Manager supports patients, healthcare providers, and program partners by managing reimbursement and insurance verification processes. This role ensures timely benefit verification, resolves complex payer issues, and helps patients access medication therapies efficiently. Success in this position is measured by accuracy, responsiveness, and the ability to navigate insurance and funding programs with minimal supervision.

KEY RESPONSIBILITIES

• Handle inbound calls and prioritize customer inquiries within defined SLAs.

• Conduct insurance benefit verifications and re-verifications for high-volume case loads.

• Facilitate prior authorization processes, appeal management, and resolution of claim denials.

• Collaborate with healthcare providers, payers, and manufacturer representatives to advocate for product coverage.

• Analyze payer trends, report outcomes, and research alternate funding sources for patient assistance programs.

MINIMUM QUALIFICATIONS

• High School Diploma or equivalent required.

• 5+ years of experience in healthcare, including Medicare/Medicaid administration, billing, or insurance verification.

• Minimum 2 years of customer service and medical or insurance industry experience.

• Strong communication, problem-solving, and organizational skills.

• Ability to work independently and manage multiple priorities in a fast-paced environment.

CORE TOOLS & SYSTEMS

• Microsoft Office Suite (Excel, Outlook, Word)

• Insurance and benefits verification platforms

• EMR/EHR or claims adjudication systems

• CRM/case management software

PREFERRED SKILLS

• Background in pharmacy or pharmaceutical reimbursement support

• Experience advocating for payer coverage and conducting appeals

• Familiarity with alternate funding programs or patient assistance initiatives

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