Case Manager - Healthcare Appeals & Patient Access Advocate

The Case Manager is a professional external-facing role, which is responsible for oversight of cases throughout the authorization/approval journey for patients and their providers. This role relies on critical thinking skills to drive cases through complex communication, 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 commercial or government-run insurers, healthcare providers, suppliers/distributors, and patients to ensure access across the care continuum. Core Duties/Responsibilities: Act as a single point of contact between the internal team, client, providers, payor, facility, and patient as needed. Support cases through approval/denial process with a sense of urgency while maintaining accuracy. Collaborate and provide direction to the internal and external stakeholders (i.e., Payor Specialist Team, Reimbursement Team, Clinical Team, client sales/MSL) and coordinate efforts to ensure accuracy and completeness of each case. Identify and share trends impacting business processes with management. Prioritize and act on key client activities and follow up with customers to ensure problems are solved. Manage through ambiguity while designing innovative client and payor solutions. Make sound independent decisions in urgent and non- routine situations pertaining to client and patient scenarios. Interpret complex clini