You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a dedicated Medical Case Manager responsible for the end-to-end management of patient cases, from referral to triage. This role involves coordinating benefits, securing prior authorizations, and facilitating prescription transfers to specialty pharmacies. The Medical Case Manager acts as a vital link between patients, medical offices, insurance providers, and internal teams, ensuring high-quality support, accurate documentation, and effective communication throughout the patient's healthcare journey.

Key Responsibilities

• Manage cases end-to-end, including benefit verification, prior authorization support, and triage to specialty pharmacies.
• Coordinate prescription transfers based on established triage guidelines.
• Communicate with insurance providers to verify pharmacy and medical benefits.
• Collaborate with medical offices (MDOs) to obtain and confirm patient information.
• Support prior authorizations and appeals processes as needed.
• Serve as primary point of contact for inbound calls, case inquiries, and follow-ups.
• Document case activity accurately within system tools.
• Provide information on financial assistance and funding options.
• Partner with internal teams and manufacturer representatives to ensure alignment on patient care.
• Troubleshoot and resolve complex or escalated cases.
• Maintain compliance with HIPAA and confidentiality standards.

Qualifications

• 3+ years of direct, end-to-end ownership of benefit investigations and prior authorizations (payer outreach, documentation follow-up, approvals).
• 1+ year of specialty pharmacy experience.
• Ability to independently manage and drive cases to resolution.
• Proficient in Microsoft Office and case management tools; HIPAA compliant.
• High school diploma or GED.
• Bilingual (Spanish/English) is preferred.
• Experience in a healthcare hub, specialty pharmacy, or patient access setting is preferred.
• Certified Medical Assistant (CMA) or Certified Pharmacy Technician (CPhT) is preferred.
• Familiarity with EMR or CRM systems (e.g., Salesforce, Zendesk) is preferred.
• Experience supporting field access or pharmaceutical sales teams is preferred.

Experience

• Minimum 3 years of direct, end-to-end ownership of benefit investigations and prior authorizations.
• Minimum 1 year of specialty pharmacy experience.

Skills

• Proficient in Microsoft Office and case management tools.
• Strong understanding and adherence to HIPAA compliance.
• Excellent independent case management and resolution capabilities.
• Familiarity with EMR or CRM systems (e.g., Salesforce, Zendesk) is preferred.

Education

• High school diploma or GED is required.
• Certified Medical Assistant (CMA) or Certified Pharmacy Technician (CPhT) is preferred.

Additional Requirements

• Must be flexible to work any 8-hour shift, Monday-Friday between 8am-8pm EST.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients