Executive Case Manager

Valeris • Jeffersonville, IN

17d • Onsite

About The Position

The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers, and clients. The role educates patients, caregivers, and healthcare provider offices about access and reimbursement support tools, program benefits and eligibility, payer processes, and available coverage options. Working through a contact center, the Executive Case Manager handles inbound and outbound communications with patients, caregivers, specialty pharmacies, healthcare professionals, and client stakeholders. The role provides personalized case management, supports patients and HCPs in navigating next steps toward medication coverage and access, and follows program guidelines, applicable laws, regulations, and industry standards.

Requirements

• Completion of a bachelor’s degree or higher, or qualifying relevant experience or certifications as described in the posting.
• Strong understanding of medical terminology, coding systems such as ICD-10, CPT, and HCPCS, and insurance processes.
• Demonstrated ability to work within guardrails, recognize urgency, and consistently deliver patient-centered results.
• Excellent attention to detail and organizational skills.
• Ability to prioritize tasks and work efficiently in a fast-paced environment.
• Effective written and verbal communication and interpersonal skills, including the ability to interact professionally with diverse stakeholders.
• Ability to think critically and resolve issues.
• Knowledge of healthcare compliance regulations, including HIPAA and Medicare/Medicaid guidelines.
• The posting prefers candidates able to type at least 35 words per minute with 97% accuracy.

Nice To Haves

• A degree in healthcare administration, social science, or a similar related field.
• At least two years of experience in healthcare access delivery or management.
• Five to ten years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education may be considered in lieu of a degree.
• Other certifications and five or more consecutive years of experience in a relevant field may be considered; examples include PACS, CHES, or CCM.
• Bilingual skills.
• Flexibility to travel as needed.

Responsibilities

• Build trusted relationships with patients, prescribers, and appropriate client stakeholders through proactive communication, timely and accurate execution, and a strong focus on helping patients.
• Manage relationships and communications in compliance with applicable laws, regulations, program operating procedures, industry standards, HIPAA, insurance guidelines, and client protocols.
• Handle inbound and outbound calls to patients, caregivers, specialty pharmacies, and healthcare professionals within a contact center structure.
• Conduct post-Benefits Investigation calls to patients and/or physicians to explain coverage options and next steps in the access journey.
• Manage client inquiries, including case-specific status inquiries, and HCP inquiries in accordance with business rules.
• Manage inbound calls according to program-approved FAQs and triage patients to internal or external resources as appropriate.
• Provide personalized case management to patients and HCPs, including outbound communications about benefit coverage and next steps for obtaining coverage or access to prescribed medicine.
• Use electronic tools to identify benefits and payer coverage, and complete manual benefit investigations when needed.
• Identify and communicate plan coverage details, including prior authorization, appeals, tier exceptions, and formulary exclusions.
• Serve as an internal subject matter expert when appropriate.
• Use electronic resources to obtain benefit coverage outcomes and contact payers and HCPs as needed to follow up on submissions or outcomes.
• Coordinate nurse teaching with nurse educators when applicable to the program.
• Support adherence services when applicable to the program.
• Identify peer support resources for patients.
• Proactively communicate needs for prior authorization reverification or re-enrollment.
• Identify and report adverse events, product complaints, special situation reports, and medical inquiries in accordance with program procedures and business rules.
• Document activities in the PharmaCord Lynk system, maintaining detailed reimbursement records, including claims status, payments, and appeals.
• Generate reports and analyses as needed to identify trends and opportunities for improvement in accordance with business requirements.
• Use Valeris’ values to drive team success, meet training deadlines for corporate policies and procedures, and follow SOPs consistently.
• Perform additional tasks or projects as assigned.

Benefits

• Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs.
• Telehealth and Employee Assistance Program (EAP) services.
• Company match on Health Savings Account contributions.
• Free basic life and AD&D coverage equal to annual earnings, with a minimum of $50,000 and a maximum of $300,000.
• Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability.
• 401(k) Retirement Savings Plan with a 100% match on the first 5% contributed and immediate vesting.
• Paid Time Off (PTO) and Sick Leave.
• Nine paid holidays plus two floating holidays.
• Opportunities for advancement and personal and professional growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level