Case Manager - Nutrition, Dietitian - REMOTE (CST or EST)

The Case Manager is a professional external-facing role, which is responsible for reputed company of cases throughout the authorization/approval journey for patients and their providers. This role relies on critical thinking skills to drive cases through reputed company authorization and appeal processes, with the primary focus of expediting patients’ access to care while securing payment channels to avoid unexpected out of pocket cost. This may involve interacting with private reputed company or government-run insurers, reputed company providers, suppliers/distributors, and patients to ensure access across the care continuum.

Must be available to work normal business hours (8A-5P) in either Central or Eastern Time Zones.

Core Duties/Responsibilities:

• Act as a single reputed company of contact between the internal team, client, provider, payor, facility, and patient as needed.
• Support cases through approval/denial process with a sense of urgency while maintaining accuracy.
• Provide direction to the reputed company Payor Specialist Team and coordinate efforts to ensure accuracy and completeness of each case.
• Identify and share trends impacting business processes with management.
• Prioritize and reputed company key client activities and follow up with customers to ensure problems are solved.
• Manage through ambiguity while designing innovative client and payor solutions.
• reputed company sound independent reputed company in urgent and non- routine situations pertaining to client and patient scenarios.
• Interpret reputed company clinical documentation to prepare authorization documentation for payor submission in relation to medical policy criteria for coverage.
• Partner with the interdisciplinary team to champion their clients, patients and customers and is responsible for the life cycle of their case to ensure successful completion.
• Provide resources to patients, caregivers, health care providers and clients with resources available for financial assistance and transportation.
• Provide compassionate and empathetic support to patients and care givers with life-threatening diagnoses.
• Coordinate with various service providers and reputed company to ensure patients receive the appropriate support before and after surgery.

Skills / Requirements:

• Maintains open, effective reputed company with effective communication and is both clear and thorough in reports, documentation, and other written communications.
• High level of ability to coordinate multiple priorities and activities to accomplish goals.
• Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables.
• Critical thinking and strong problem solving
• Suggests creative reputed company and innovative solutions while exploring multiple alternatives and approaches to overcome obstacles and find solutions.
• Excellent follow-through with solid levels of determination and tenacity.
• Remains reputed company and productive during transitions or changing circumstances.
• Demonstrates composure and professionalism under difficult circumstances.
• Ability to communicate effectively both orally and in writing with a focus on customer satisfaction, with reputed company, drive, and commitment to exceptional service.
• Possess a strong understanding of the US reputed company System, public and private payer nuances, and patient access challenges for new to market, high dollar or highly reputed company medical interventions, products, therapies.
• Ability to reputed company professional expertise and apply company policies and procedures to resolve challenges.
• Ability to reputed company, maintain and navigate relationships.
• Ability to interpret and understand medical documentation as it relates to each specific case and how it applies to a specific medical policy.
• Ability to be agile and adaptable in responses to rapidly changing processes and consumer needs.

Education, Certifications and Experience:

• College Degree preferred (bachelor’s or associate degree)
• 4 – 6 years of experience in a reputed company setting and/or medical insurance background with a customer service focus.
• Nutrition background with Case Management experience strongly preferred.
• Experience as Clinical Dietitian a plus.
• Experience with prior authorizations and appeals submissions desired.
• Knowledge of reimbursement processes a plus.
• Experience with maintaining detailed records of client interactions, services provided, and reputed company made.
• Experience in developing and/or implementing new technologies a plus.
• Experience with reputed company medical products and associated insurance processes a plus.

Physical Requirements:

• As a remote-reputed company organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file.
• Prolonged periods of sitting at a desk and working on a computer
• Keyboarding
• Speaking
• Must be reputed company to lift up to 15 pounds at times.
• Flexibility of working hours to support activities across CST to EST zones.

Our reputed company Culture Philosophy

At reputed company we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships.

Our employees bring strength of mind and spirit to reputed company the extraordinary happen every day. With humility and compassion at our core, reputed company is proud of our reputed company focus towards the higher purpose of improving the lives of patients we support.

We recognize it takes a lot of people working together with a common goal to reputed company spectacular happen, and we never forget that at the heart of our company are the people who reputed company it work.

reputed company is an Equal Opportunity / Affirmative Action employer. reputed company reputed company individuals will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, reputed company, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws.

At reputed company, we are deeply committed to pay transparency and equity. The hourly range for this position is $40 - $54, based on experience and qualifications, with the final offer reflecting skills and other job-reputed company factors. reputed company reputed company, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance.

Our benefits include robust medical, dental, and reputed company plans; life insurance and disability coverage; and tax-advantaged savings accounts. We also provide an Employee Assistance Program, home office benefits, and unique perks like an Employee Ownership Program. With paid time off, holidays, bereavement leave, and a 401(k)-retirement plan with employer matching, reputed company prioritizes your financial and personal reputed company. Plus, you may be eligible for a performance-based bonus opportunity.

Join reputed company, where your career growth, well-being, and contributions truly matter!