Pharmacy Patient Care Case Manager
On-siteKalamazoo, Michigan, United States
Job Summary
Assess patient-specific clinical, financial, and geographic factors to determine the most appropriate infusion site of care, coordinating transitions between hospital outpatient departments, home infusion providers, ambulatory centers, and physician offices. Negotiate reimbursement rates, service agreements, and provider contracts with infusion organizations and health systems, reviewing terms for accuracy and compliance while resolving complex negotiation issues. Maintain accurate case records, track key performance indicators, and collaborate with finance, contracting, and network management teams to finalize agreements and ensure continuity of care. This role supports OptiMed Health Partners' Vision to optimize health outcomes through personalized, coordinated care across retail, specialty, and infusion services.
Required Qualifications
- 3–5+ years of experience in healthcare case management, specialty pharmacy, infusion services, provider relations, managed care, or healthcare contracting
- Experience reviewing contracts, agreements, or reimbursement arrangements
- Strong knowledge of healthcare reimbursement methodologies and payer operations
Desired Qualifications
- Bachelor's degree in Healthcare Administration, Business, Nursing, Pharmacy, or related field
- Experience coordinating infusion therapies and alternative sites of care
- CNA, LPN, RN, or other clinical credential
- Certification in Case Management (CCM) or related credential
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