Forney, TX

Prior Authorization Pharmacy Case Manager

Pay: $20.00/hour
Job Type: Full-Time | Remote | 40 Hours per Week

Are you passionate about helping patients navigate the healthcare system? We are seeking experienced Case Managers to support patients through the medication access process, ensuring they receive the therapies they need. This is an excellent opportunity for professionals with experience in patient access, benefit verification, prior authorizations, specialty pharmacy, or healthcare reimbursement.

• $20.00 per hour
• Full-time, 40 hours per week
• Remote position with company-provided equipment

As a Case Manager, you will manage patient cases from initial enrollment through medication access and delivery while providing exceptional customer service.

• Manage patient cases from benefit investigation through medication delivery.
• Complete benefit verifications for commercial insurance, Medicare, and Medicaid plans
• Coordinate with physician offices, specialty pharmacies, insurance carriers, and patients.
• Process prior authorizations and assist with appeals when necessary.
• Educate patients on insurance coverage, out-of-pocket costs, and available assistance programs.
• Handle inbound and outbound calls to resolve patient questions and case updates.
• Process enrollments received via phone, fax, and electronic submissions.
• Review documentation for accuracy and obtain missing information as needed.
• Maintain detailed documentation within internal systems.
• Prioritize cases to ensure timely patient access to therapy.

• 2+ years of experience in patient access, healthcare case management, benefit verification, specialty pharmacy, or a related healthcare support role
• Strong customer service and communication skills
• Excellent computer and data entry skills
• Ability to work independently in a fast-paced environment.
• High School Diploma or equivalent

• Previous Hub Services or Patient Support Program experience
• Experience with benefit investigations, insurance verification, prior authorizations, and appeals
• Knowledge of Medicare, Medicaid, and commercial insurance plans
• Understanding of specialty medications and medication adherence

• Mandatory Paid Training:
  October 5 – November 6
• Training
  
  Hours:
  
  Monday-Friday, 8:0 AM – 5:0 PM Central Time
• Go Live Date:
  November 9
• After training, employees must be available to work assigned shifts between:
• • Monday-Friday
  • 7:00 AM – 8:00 PM Central Time

• Complete approximately 2-3 patient cases per hour
• Make an average of 10 outbound calls per day.
• Manage patient follow-up activities including:
• • Proof of income requests
  • Refill coordination
  • Benefit follow-up
  • General case management and triage

• A dedicated, quiet workspace free from distractions
• High-speed wired internet connection (DSL, Cable, or Fiber)
• Minimum download speed of 15 Mbps
• Minimum upload speed of 5 Mbps
• Hardwired Ethernet connection (Wi‑Fi, satellite, and cellular internet are not permitted)
• Surge protector with network line protection.

• Company‑issued computer and equipment will be provided.

Candidates with experience in any of the following roles are encouraged to apply:

• Case Manager
• Patient Access Specialist
• Benefits Investigation Specialist
• Prior Authorization Specialist
• Hub Services Coordinator
• Pharmacy Case Manager
• Reimbursement Specialist
• Specialty Pharmacy Representative

Schedule:

Full-Time | Monday-Friday | Flexible shifts between 7:00 AM-8:00 PM Central Time

Please note:

Resumes should clearly demonstrate experience with benefit verification, insurance investigations, prior authorizations, patient access, specialty pharmacy, or similar case management responsibilities.

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