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Job Requirements of Case Manager:
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Employment Type:
Full-Time
-
Location:
Texas, US (Onsite)
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Case Manager
Tailored Management Services Inc
Texas, US (Onsite)
Full-Time
Job Title: Case Manager
Location: 100% Remote
Pay: $20/hour plus paid weekly!
Schedule: Contract to hire | Monday to Friday, 7:00 AM to 7:00 PM CST (8 hours/day)
Training: 4 to 6 weeks of mandatory virtual training, Monday to Friday, 8:00 AM – 5:00 PM CST. 100% attendance required—no pre-planned time off accepted during training.
About the Role:
This position supports specialty pharmaceutical manufacturers in eliminating barriers to care so that patients can access, afford, and stay on life-changing therapies. Our non-commercial specialty pharmacy and custom-designed facility near Dallas, Texas, support streamlined patient onboarding, qualification, and adherence. Join our mission to deliver therapies faster and more effectively by guiding patients throughout their care journey with compassion and precision.
Key Responsibilities:
• Manage the full care process with urgency—from benefit verification to medication delivery—ensuring an exceptional patient experience.
• Conduct benefit investigations and collaborate with healthcare providers, specialty pharmacies, and insurers to ensure coordinated care.
• Assist in obtaining prior authorizations, insurance approvals, and appeal outcomes.
• Educate patients on their insurance coverage, out-of-pocket costs, and the appeals process.
• Address and resolve patient and provider concerns regarding case status.
• Maintain expertise in payer landscapes and remain informed on reimbursement changes across Medicare, Medicaid, Managed Care, and Commercial plans.
• Process patient enrollments via fax, phone, or electronically as needed.
• Review and verify accuracy of forms and documentation for data entry.
• Support the inbound call queue from patients, providers, and partners—aiming for first-call resolution.
Qualifications and Skills:
• 2–4 years of experience in a patient-facing or high-touch customer service role, preferred.
• Previous experience in Hub Services or Patient Support Programs, preferred.
• High School diploma or equivalent, preferred.
• Knowledge of Medicare (Parts A, B, C, D), Medicaid, and Commercial payer guidelines, preferred.
• Strong interpersonal skills—flexible, empathetic, persistent, and trustworthy.
• Proficient in data entry and Microsoft Office tools.
• Understanding of pharmaceutical therapies, disease states, and adherence challenges, preferred.
• Excellent written and verbal communication and problem-solving skills.
#TMCS
Location: 100% Remote
Pay: $20/hour plus paid weekly!
Schedule: Contract to hire | Monday to Friday, 7:00 AM to 7:00 PM CST (8 hours/day)
Training: 4 to 6 weeks of mandatory virtual training, Monday to Friday, 8:00 AM – 5:00 PM CST. 100% attendance required—no pre-planned time off accepted during training.
About the Role:
This position supports specialty pharmaceutical manufacturers in eliminating barriers to care so that patients can access, afford, and stay on life-changing therapies. Our non-commercial specialty pharmacy and custom-designed facility near Dallas, Texas, support streamlined patient onboarding, qualification, and adherence. Join our mission to deliver therapies faster and more effectively by guiding patients throughout their care journey with compassion and precision.
Key Responsibilities:
• Manage the full care process with urgency—from benefit verification to medication delivery—ensuring an exceptional patient experience.
• Conduct benefit investigations and collaborate with healthcare providers, specialty pharmacies, and insurers to ensure coordinated care.
• Assist in obtaining prior authorizations, insurance approvals, and appeal outcomes.
• Educate patients on their insurance coverage, out-of-pocket costs, and the appeals process.
• Address and resolve patient and provider concerns regarding case status.
• Maintain expertise in payer landscapes and remain informed on reimbursement changes across Medicare, Medicaid, Managed Care, and Commercial plans.
• Process patient enrollments via fax, phone, or electronically as needed.
• Review and verify accuracy of forms and documentation for data entry.
• Support the inbound call queue from patients, providers, and partners—aiming for first-call resolution.
Qualifications and Skills:
• 2–4 years of experience in a patient-facing or high-touch customer service role, preferred.
• Previous experience in Hub Services or Patient Support Programs, preferred.
• High School diploma or equivalent, preferred.
• Knowledge of Medicare (Parts A, B, C, D), Medicaid, and Commercial payer guidelines, preferred.
• Strong interpersonal skills—flexible, empathetic, persistent, and trustworthy.
• Proficient in data entry and Microsoft Office tools.
• Understanding of pharmaceutical therapies, disease states, and adherence challenges, preferred.
• Excellent written and verbal communication and problem-solving skills.
#TMCS
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