Reimbursement Case Manager

the Opportunity•Lake Mary, FL

3d•Remote

About The Position

This role requires working 11-8pm Monday-Friday. TalentBridge is partnering with a leading healthcare services organization specializing in pharmaceutical patient support, specialty pharmacy, and reimbursement services to hire experienced Reimbursement Case Managers. This is an exciting opportunity for healthcare professionals who are passionate about helping patients navigate complex insurance and reimbursement challenges to access life-changing specialty therapies. Unlike traditional Benefits Verification or Reimbursement Specialist positions, this role provides full-cycle case management, allowing you to serve as a dedicated point of contact for patients, caregivers, and healthcare providers throughout the treatment journey. The ideal candidate has experience in pharmaceutical HUB services, specialty pharmacy, patient access, or complex reimbursement and enjoys building relationships, resolving challenges, and advocating for patients.

Requirements

3+ years of experience in specialty pharmacy, pharmaceutical HUB services, patient access, medical insurance, healthcare reimbursement, or a related healthcare setting.
Experience managing patient cases and coordinating multiple steps of the reimbursement and therapy access process.
Knowledge of medical and pharmacy benefits, benefits investigations, prior authorizations, appeals, and patient assistance programs.
Familiarity with commercial insurance, Medicare, Medicaid, and other payer requirements.
Experience communicating directly with patients, physician offices, insurance companies, and specialty pharmacies.
Strong patient advocacy and relationship-building skills.
Excellent verbal and written communication.
Ability to independently manage a caseload, prioritize tasks, and meet deadlines.
Strong analytical thinking and problem-solving abilities.
Exceptional attention to detail and documentation accuracy.
Ability to navigate complex insurance and reimbursement situations.
Knowledge of HIPAA and patient confidentiality requirements.
Proficiency with Microsoft Office, including Word and Excel.
Experience using healthcare CRM, case management, or patient support platforms.
Ability to thrive in a fast-paced, team-oriented environment while maintaining a patient-first approach.

Nice To Haves

Bachelor's degree preferred; equivalent professional experience considered.

Responsibilities

Full-Cycle Patient Case Management: Serve as the primary point of contact for assigned patients, caregivers, and healthcare providers throughout the patient access journey. Manage an assigned caseload from initial enrollment through reimbursement approval, therapy initiation, and ongoing patient support. Build relationships with patients and providers while serving as a trusted resource and patient advocate. Coordinate access to specialty therapies and connect patients with appropriate support services. Conduct regular follow-ups with patients, physician offices, pharmacies, and insurance providers to keep cases moving forward. Identify and proactively resolve barriers that could delay treatment. Maintain accurate and thorough case documentation within patient management systems.
Reimbursement & Insurance Navigation: Conduct benefits investigations and verify medical and pharmacy insurance coverage. Coordinate prior authorizations, appeals, and reimbursement-related activities. Research insurance requirements, payer policies, coverage limitations, and reimbursement options. Assist patients and providers with enrollment in copay assistance, patient assistance, and other financial support programs. Guide physician offices and patients through required applications, documentation, and submission processes. Help resolve insurance denials, coverage challenges, and other obstacles impacting therapy access. Communicate reimbursement information clearly to patients, caregivers, and healthcare providers.
Patient Advocacy & Collaboration: Provide compassionate, knowledgeable, and responsive support to patients navigating complex medical treatments. Maintain frequent communication with patients, healthcare providers, specialty pharmacies, payers, and internal teams. Coordinate with cross-functional departments to ensure timely resolution of patient access issues. Manage escalated inquiries and complex cases with professionalism and sound judgment. Deliver exceptional service while balancing case management productivity and quality expectations. Ensure compliance with HIPAA, program guidelines, standard operating procedures, and adverse event reporting requirements.