Reimbursement Case Manager

Job overview

The Reimbursement Case Manager role has a hybrid work arrangement, combining remote work and in-office requirements, with the office within commuting distance of Pittsburgh, PA. Compensation is not specified in the posting. The role supports RareMed Solutions’ reimbursement and patient-access programs. The case manager helps patients access prescribed therapy by verifying benefits and coverage, supporting prior authorizations and appeals, and responding to reimbursement inquiries. The position coordinates with payers, specialty pharmacies, manufacturers, healthcare providers, and internal teams while documenting cases and following service procedures and patient privacy requirements.

What you'll do

• Respond to client and customer reimbursement inquiries and escalations
• coordinate patient benefit investigations
• review forms for completeness
• apply business rules to determine eligibility for manufacturer-supported programs
• verify prescription coverage and support authorization and appeals
• contact payers to gather case information
• document accounts according to procedures
• enroll eligible patients in commercial copay programs
• process patient and prescriber requests
• communicate payer trends and access delays
• coordinate with internal teams and external stakeholders
• protect patient privacy.

What we're looking for

Skills & competencies

reimbursement case manager

patient access

benefits investigation

prescription coverage

prior authorization

appeals support

payer communication

specialty pharmacy

hybrid work

pittsburgh commuting distance

raremed solutions

monday–friday schedule

Work arrangement

• Weekend coverage required

Why this role

Hybrid work with in-office requirements and commuting distance to Pittsburgh; schedule may fall between 8:00 a.m. and 8:00 p.m. Eastern, Monday through Friday; requires a high school diploma and 2+ years of recent reimbursement experience.

About the employer

RareMed Solutions is hiring for this role. Industry: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. Sector: 52.