Case Manager

The Case Manager will coordinate with patients, healthcare providers, insurance companies, specialty pharmacies, and other stakeholders to help ensure timely access to prescribed therapies. This role requires strong case management, care coordination, insurance reimbursement, patient advocacy, and communication skills , along with the ability to manage multiple cases independently.

Job Title: Case Manager.
Location: Pittsburgh, PA 15275
Duration: 4 -6+ Month Contract
Schedule: Monday–Friday: 8:00 AM – 4:30 PM, 8:30 AM – 5:00 PM
 
Job Summary:
We are seeking an experienced Case Manager to support patients with chronic illnesses by assessing their healthcare needs, treatment journey, and care plans. The Case Manager will coordinate with patients, healthcare providers, insurance companies, specialty pharmacies, and other stakeholders to help ensure timely access to prescribed therapies.
This role requires strong case management, care coordination, insurance reimbursement, patient advocacy, and communication skills, along with the ability to manage multiple cases independently.
Key Responsibilities

• Manage the care coordination process within an assigned territory.
• Assess patient and physician needs and develop action plans to prevent delays in therapy.
• Coordinate patient-related information among patients, families, healthcare providers, insurance companies, and specialty pharmacies.
• Establish and maintain professional relationships with internal and external partners.
• Manage case information, including patient details, insurance coverage, approvals, ongoing requirements, and interactions.
• Assist with benefit investigations as required by the program.
• Assist with obtaining insurance approvals, denials, and appeals for designated therapies.
• Support patients and healthcare providers with Copay Assistance, Reimbursement, and Patient Assistance Program applications.
• Assist with prescription ordering and triage for patients and healthcare providers.
• Educate patients and healthcare providers regarding insurance requirements, coverage options, limitations, and therapy access.
• Provide relevant disease and product education as appropriate.
• Maintain knowledge of reimbursement processes, billing and coding requirements, insurance plans, payer trends, financial assistance programs, charitable resources, and alternative access options.
• Exercise independent judgment and discretion when handling complex cases and sensitive patient matters.
• Identify opportunities for process improvements and support operational efficiency.
• Participate in special projects and contribute to team initiatives.
• Share knowledge with team members through training, case studies, and consultation on complex cases.
• Maintain accountability for action plan execution and case resolution.

Required Qualifications

• Bachelor’s degree or equivalent experience in a related field such as Healthcare, Social Work, or Nursing preferred.
• 3+ years of recent case management experience preferred.
• Experience in one or more of the following areas is highly preferred:
  • Case management
  • Home care management
  • Utilization review
  • Social services
  • Insurance reimbursement
  • Patient advocacy
  • Care coordination
• Strong understanding of healthcare insurance benefits, payer requirements, and applicable state and federal regulations.
• Strong computer skills and experience with data entry and case management systems.
• Demonstrated case management expertise and leadership abilities.
• Excellent verbal and written communication skills.
• Strong mediation, problem-solving, and critical-thinking skills.
• Ability to communicate professionally and effectively with patients, healthcare providers, clients, insurance companies, and internal teams.
• Ability to handle sensitive situations involving differing opinions and perspectives.
• Ability to work independently while managing multiple cases and priorities.