Case Manager

Job Title: Case Manager
Department: Operations
FLSA: Non-Exempt
Revision Date: 07/01/2021


The Case Manager is responsible for providing timely, knowledgeable, and courteous resolution and response to pharmacy-, member-, and product-related inquiries. The Case Manager works under the general direction and guidance of the Director of Customer Service and reports directly to the Customer Service Supervisor.

Essential Functions

  • Answer and respond to calls and emails.
  • Resolve pharmacy issues from members, providers, and pharmacies.
  • Respond to routine inquiries on multiple products from members, providers, pharmacies, and employer groups.
  • Research required information using available resources.
  • Place outgoing phone calls when business circumstances warrant.
  • Route calls to appropriate resource.
  • Document all call information according to standard operating procedures.
  • Enter data accurately and timely.
  • Maintain a positive and professional demeanor.
  • Utilize multiple company database programs for accessing member information.
  • Achieve individual performance goals for productivity and quality.
  • Maintain confidentiality of patient and proprietary information.
  • Other duties as assigned.

Position Requirements

  • High school diploma or GED
  • Proficient in Microsoft Office and industry related software programs
  • Effective verbal and written communication skills
  • Excellent telephone etiquette skills with a strong customer focus
  • Ability to independently identify, research and resolve issues
  • An intelligent and articulate individual who can relate to people at all levels
  • Demonstrated ability to manage multiple priorities and deadlines
  • A well-organized and motivated individual who can work both independently and in a team setting
  • Ability to efficiently complete tasks in a fast-paced environment
  • Ability to exercise good judgment, maintain confidentiality and diplomacy

Desired Qualifications

  • Customer Service or Call center experience
  • working knowledge of Pharmacy Benefit Manager (PBM) operations
  • Ability to work weekends and holidays

Tools and Equipment Used

The occupant is expected to freely operate the following tools and equipment: personal computer printer; calculator; telephone; copier; fax machine.

Working Environment

Work is performed in an office / call center environment, with no to minimal exposure to noise and adverse environmental conditions.

Physical Demands

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, carry or operate objects, tools or controls and reach with hands and arms. The employee frequently is required to stand; talk or hear; walk, sit. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.




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