Case Manager - Nutrition, Registered Dietitian, Enteral w/Pediatrics a Plus!
$83,200–$112,320 year
RemoteUnited States
Job Summary
Act as the single point of contact between internal teams, clients, providers, payors, and patients to oversee cases through authorization, approval, and appeal processes. Interpret complex clinical documentation to prepare authorization submissions for payor review while coordinating with the Payor Specialist Team to ensure accuracy. Prioritize client activities, manage ambiguity, and make independent decisions in urgent situations to expedite patient access to care. Provide resources for financial assistance and transportation, and partner with interdisciplinary teams to champion clients throughout the case lifecycle. Maintain open dialogue with all stakeholders, track trends impacting business processes, and resolve challenges using critical thinking and strong problem-solving skills.
Required Qualifications
- Maintains open, effective dialogue 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
- Excellent follow-through with solid levels of determination and tenacity.
- Remains calm 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 empathy, drive, and commitment to exceptional service.
- Possess a strong understanding of the US Healthcare System, public and private payer nuances, and patient access challenges for new to market, high dollar or highly complex medical interventions, products, therapies.
- Ability to leverage professional expertise and apply company policies and procedures to resolve challenges.
- Ability to develop, 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.
- 4 – 6 years of experience in a healthcare setting and/or medical insurance background with a customer service focus.
- Must be able to lift up to 15 pounds at times.
- Working hours to support activities in multiple time zones.
Desired Qualifications
- College Degree is preferred (Bachelor's or Associate Degree).
- Nutrition background with Case Management experience strongly preferred.
- Experience as a 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 progress made.
- Experience in developing and/or implementing new technologies a plus.
- Experience with complex medical products and associated insurance processes a plus.
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