Clinical Financial Case Manager Senior Pharmacy Denial Management (s4)
Ohio State University Physicians Inc
Remote, US
Fully remote
Pharmacy denial management
Clinical reviews
Submit and track appeals
The Clinical Financial Case Manager – Senior Pharmacy Denial Management is responsible for managing complex pharmacy-related medication denials across the health system
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
The Clinical Financial Case Manager – Senior Pharmacy Denial Management is responsible for managing complex pharmacy-related medication denials across the health system.
Skills & Requirements
Must-have
Pharmacy denial management
Clinical reviews
Submit and track appeals
Electronic medical records
Medicare and commercial insurance reimbursement
ICD-10 codes
Nice-to-have
Process improvement initiatives
Mentoring staff
Collaborating with providers
Patient access advocacy
Revenue integrity protection
Key Requirements
Minimum 6 years’ experience
Bachelor’s degree required
Ability to communicate clearly
Experience with Microsoft Office
Experience with electronic medical records
Experience with intranet/internet navigation tools