Clinical Financial Case Manager Senior Pharmacy Denial Management (s4)

The Ohio State University

Remote, , US
Fully remote
Managing medication denials
Submitting and tracking appeals
Navigating electronic medical records
The Ohio State University is seeking a Clinical Financial Case Manager for Senior Pharmacy Denial Management, responsible for handling complex pharmacy-related medication denials remotely. The role requires significant experience in healthcare, particularly with insurance appeals and reimbursement processes

Job Summary

  • The Clinical Financial Case Manager – Senior Pharmacy Denial Management is responsible for managing complex pharmacy-related medication denials across the health system.
  • Key duties include conducting comprehensive clinical reviews, submitting and tracking appeals, and ensuring timely resolution in alignment with payer guidelines.
  • Additional responsibilities include leading process improvement initiatives, mentoring staff, and collaborating with providers, payors, and internal teams to enhance patient access and protect pharmacy revenue integrity.

Matching Summary

Match Score: 85

The Ohio State University is seeking a Clinical Financial Case Manager for Senior Pharmacy Denial Management, responsible for handling complex pharmacy-related medication denials remotely. The role requires significant experience in healthcare, particularly with insurance appeals and reimbursement processes.

Skills & Requirements

Must-have

  • managing medication denials
  • submitting and tracking appeals
  • navigating electronic medical records
  • interpreting clinical and billing data
  • Medicare and commercial insurance reimbursement

Nice-to-have

  • leading process improvement initiatives
  • mentoring staff
  • collaborating with providers and payors

Key Requirements

  • Minimum 6 years’ experience
  • Bachelor’s degree required
  • Advanced degree preferred
  • Experience in finance, insurance, insurance appeals
  • Ability to communicate clearly
  • Microsoft Office, EMR, internet navigation
  • Highly organized, detail oriented
  • Advanced knowledge of Medicare and commercial insurance reimbursement
  • Strong knowledge of ICD-10 codes

Work Rights

Not specified

Tailored Resume

Cover Letter