Case Manager

ConnectiveRx • Pittsburgh, PA

83d • $41,800 - $55,500

About The Position

The Benefits Investigation Specialist position at ConnectiveRx is crucial for ensuring access to essential medications. The role involves engaging with Medical Insurance Payers and Pharmacy Benefit Managers to identify and document coverage options for retail and specialty medications. The Case Manager will assist customers with chronic illnesses by gaining access to their wellbeing needs and treatment plans, collaborating with internal and external partners to resolve issues and maintain compliance. The position starts in the office but will transition to a hybrid model in early 2026.

Requirements

• Bachelor’s Degree (or equivalent) in Health Care, Social Work, Nursing, preferred.
• Minimum of three (3) years of recent experience with health care insurance benefits.
• Proven ability to assess the ethics and legality of patient care.
• Recent experience in the case management process is preferred.
• In-depth understanding of health care insurance benefits and relevant laws.
• Experience with data entry and computer literacy skills.
• Strong verbal and written communication skills.
• Ability to identify and handle sensitive issues with opposing opinions.
• Proven ability to work independently and manage multiple tasks.

Nice To Haves

• Experience in home care management, case management review, and patient advocacy.
• Ability to speak Spanish is a plus.
• Exhibits a high level of case management expertise and demonstrated leadership skills.

Responsibilities

• Manage the Care Coordination process within an assigned territory.
• Establish and maintain professional relationships with internal and external customers.
• Assess physicians’ needs and develop action plans to mitigate delays in therapy.
• Coordinate the exchange of patient-related information with various stakeholders.
• Manage a database of patient information, insurance coverage, and interactions.
• Stay updated on reimbursement processes, billing/coding nuances, and insurance plans.
• Assist in obtaining insurance approvals/denials and appeals for therapy.
• Provide education to patients and healthcare providers regarding insurance requirements.
• Exhibit leadership by demonstrating accountability for action plan execution.
• Identify and recommend process improvements for operational efficiencies.

Benefits

• Comprehensive medical, dental, vision, life, and disability insurance.
• 401(k) plan with employer contributions where applicable.
• Flexible paid time off (PTO) policy covering sick days, personal days, and vacations.
• Eight standard company holidays and three floating holidays annually.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees