Tailored Management
PIPELINE - Case Manager - Summit Project - Remote
Dublin, OH
Tailored Management is a global staffing firm that specializes in partnering with large organizations to provide contingent labor solutions in a VMS/MSP environment.
Job Description
PIPELINE - Case Manager - Summit Project
Posted: Wednesday, 6/18/2025
JOB TITLE: Case Manager
PAY RATE: $20.00/hour
LOCATION: 100% Remote, schedule based in Central Time
TRAINING AND WORK SCHEDULES: Your new hire training will take place M-F 8:00am-5:00pm CST, mandatory virtual attendance is required. Must attend 100% of training and pre-planned appointments/time off will not be accepted. This position is full-time (40 hours/week). 8:00am-5:00pm CST work schedule to be followed once training is complete.
Join a company that helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions driving brand and patient markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.
Together, we can get life-changing therapies to patients who need them faster.
Responsibilities
Qualifications
What is expected of you and others at this level
REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:
Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable .
PAY RATE: $20.00/hour
LOCATION: 100% Remote, schedule based in Central Time
TRAINING AND WORK SCHEDULES: Your new hire training will take place M-F 8:00am-5:00pm CST, mandatory virtual attendance is required. Must attend 100% of training and pre-planned appointments/time off will not be accepted. This position is full-time (40 hours/week). 8:00am-5:00pm CST work schedule to be followed once training is complete.
Join a company that helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions driving brand and patient markers of success. We're continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products.
Together, we can get life-changing therapies to patients who need them faster.
Responsibilities
- Manage the entire care process with a sense of urgency from benefit investigation and verification to medication delivery, ensuring an exceptional patient experience
- Conduct benefit verifications and collaborate with various healthcare providers, including physicians, specialty pharmacies, and insurance companies, to ensure seamless coordination of patient care and timely access to necessary services
- Assist in obtaining insurance, prior authorization, and appeal requirements and outcomes
- Help patients understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed
- Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance
- Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care, and Commercial medical and pharmacy plans while planning for various scenarios that may impact prescribed products
- Process enrollments via fax, phone, and electronically as needed
- Scrutinize forms and supporting documentation thoroughly for any missing information or new information to be added to the database
- Support inbound phone quue from patients, healthcare provider offices, SPs, and customers, striving for one-call resolution
Qualifications
- 2-4 years of industry experience with patient-facing or high touch customer interaction experience preferred
- Previous Hub or Patient Support Service experience preferred
- High School diploma or equivalent preferred
- Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for coverage, preferred
- Strong people skills that demonstrate flexibility, persistence, creativity, empathy, and trust.
- Robust computer literacy skills including data entry and MS Office-based software programs
- Strong understanding of pharmaceutical therapies, disease states, and medication adherence challenges preferred
- Excellent written and oral communication, mediation, and problem-solving skills, including the ability to connect with patients, caregivers, and providers
What is expected of you and others at this level
- Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments
- In-depth knowledge in technical or specialty area
- Applies advanced skills to resolve complex problems independently
- May modify process to resolve situations
- Works independently within established procedures; may receive general guidance on new assignments
- May provide general guidance or technical assistance to less experienced team members
REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:
Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable .
- Download speed of 15Mbps (megabyte per second)
- Upload speed of 5Mbps (megabyte per second)
- Ping Rate Maximum of 30ms (milliseconds)
- Hardwired to the router
- Surge protector with Network Line Protection for issued equipment
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