Pharmacy Case Manager

Pharmacy Benefits Case Manager – Remote

Pay Rate: $20.00/hour
Location: 100% Remote – U.S. Residents
Schedule: Must be available to work any 8-hour shift between 7:00 AM–7:00 PM CST
, as assigned
Training: 8:00 AM–5:00 PM CST, Monday–Friday
Training Duration: Approximately 4–6 weeks; virtual attendance is mandatory

We are seeking a Pharmacy Benefits Case Manager to support patients with prescription drug access, insurance benefits, coverage determinations, specialty pharmacy coordination, and financial assistance programs.

This position supports patients throughout the medication access process, from initial case review through final approval or denial. The ideal candidate will have experience in healthcare, insurance, pharmacy benefits, prior authorization, patient assistance, or pharmaceutical services and be comfortable handling a high volume of cases while providing an empathetic, patient-focused experience.

• Monitor system accounts for new patient cases and review incoming requests.
• Conduct outbound calls to patients regarding insurance coverage, approvals and denials, copays, and specialty pharmacy information.
• Contact insurance companies to obtain and verify accurate patient benefit information.
• Research and resolve complex payer and pharmacy-related issues.
• Assist patients, providers, and physician offices with questions regarding the status of assistance requests.
• Maintain detailed and accurate documentation in proprietary case-management systems while communicating by telephone.
• Manage patient cases from initial contact through final approval or denial.
• Process patient applications in accordance with established policies, procedures, and PHI/privacy requirements.
• Research alternative funding sources and foundations to determine patient eligibility for financial assistance.
• Communicate case updates and provide appropriate follow-up to team members and leadership.
• Identify, document, and compliantly submit Adverse Events identified during patient interactions or through received documentation.
• Apply knowledge of healthcare, pharmacy benefits, and company procedures to resolve increasingly complex cases.
• Independently research and resolve issues while working within established procedures and guidelines.
• Consistently meet established quality, productivity, and documentation standards.

• High school diploma or equivalent required.
• Previous healthcare, insurance, pharmaceutical, pharmacy, or patient support experience preferred.
• Strong verbal and written communication skills.
• Ability to multitask across multiple software applications while speaking with patients or healthcare professionals.
• Minimum typing speed of 40 WPM
  .
• Ability to accurately document and transcribe information while actively engaged in telephone conversations.
• Strong Microsoft Office skills.
• Experience using Microsoft Teams, Zoom, or similar video conferencing platforms.
• Excellent attention to detail and documentation skills.
• Ability to manage multiple concurrent cases and prioritize work in a high-volume environment.
• Strong organizational and time-management skills.
• Ability to work independently while also collaborating effectively with a team.
• Strong attendance and reliability.
• Comfortable working toward daily and weekly productivity and quality metrics.
• Empathetic, professional, and patient-focused communication style.

• Pharmacy Benefits Management (PBM) experience.
• Knowledge of Medicare, Medicaid, and commercial insurance payer practices and policies.
• Prior authorization experience.
• Appeals experience.
• Patient assistance program experience.
• Speci…