Case Manager
ConnectiveRx
Senior Case Manager
ConnectiveRx
full-time
Posted on:
Location Type: Hybrid
Location: Pittsburgh • Pennsylvania • 🇺🇸 United States
Visit company websiteSalary
💰 $54,400 - $61,800 per year
Job Level
Senior
About the role
- Responsible for handling customer concerns through research and communication with involved departments/service level agreements and client products
- Collaborates with internal and external partners and staff to achieve resolution of concerns
- Manage database for cases
- Responsible for timely case resolution and maintaining compliance
- Exhibit a high level of case management expertise and demonstrated leadership skills
- Utilize care coordination to address patient and physician concerns
- Obtain insurance approval for designated therapy and proactively plan to avoid the potential of delayed coverage
- Facilitate the case management process along the healthcare continuum
- Assist with Benefit Investigations upon program need.
- Work directly with Program Supervisor to resolve escalations with the team
- Own escalations from receipt to resolution
- Collaborate with leadership on training materials and agendas.
- Identify program gaps within flows or processes and collaborate with leadership on best practices.
- Collaborate on process updates and assist through implementation.
Requirements
- Bachelor’s Degree (or equivalent) in a related area with a focus on Health Care, Social Work, or Nursing, preferred
- A minimum of 2 years of equivalent work experience may be substituted for a degree
- Three – five (3-5) years of recent experience with health care insurance benefits, relevant state and federal laws, and insurance regulations
- Proven ability to assess the ethics and legality of patient care
- At least one (1) year of recent case management process experience preferred
- Previous experience with ConnectiveRx processes and CRM preferred
- Experience in a combination of home care management, case management review, utilization review, social service support, insurance reimbursement, and patient advocacy, preferred
- In-depth understanding of health care insurance benefits, relevant state and federal laws, and insurance regulations, highly desired
- Experience with data entry/computer literate skills preferred
- Strong verbal and written communication skills
- Mediation, and problem-solving skills
- Spanish speaking skills are a plus.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- 401(k) plan with employer contributions
- Flexible paid time off (PTO)
- Eight standard company holidays
- Three floating holidays
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementhealth care insurance benefitsinsurance regulationsdata entryutilization reviewpatient advocacybenefit investigationscare coordinationConnectiveRx processesCRM
Soft skills
leadershipcommunicationproblem-solvingmediationcollaborationresearchorganizational skillsethics assessmenttraining developmentprocess improvement
