Case Manager, Client Paid Customer Operations

Accountabilities: Coordinate complex prescription processing by verifying data accuracy, resolving insurance rejections, and ensuring all required documentation is complete.

Manage prior authorization activities, including gathering supporting documentation, submitting requests to payers, tracking progress, and following up on outstanding approvals.

Process specialty pharmacy orders and coordinate with manufacturers and other stakeholders to support timely medication fulfillment.

Monitor inventory levels and manage controlled substance orders, cycle counts, and medication recall activities.

Ensure medications are handled and stored according to applicable requirements and operational procedures.

Maintain accurate records and support compliance with applicable regulations, pharmacy requirements, and audit standards.

Troubleshoot pharmacy system issues, investigate drug-related information, and resolve billing discrepancies.

Escalate clinical, technical, or operational issues to pharmacists or appropriate internal teams when required.

Perform quality assurance activities by identifying process errors, documenting incidents, and supporting corrective and preventive actions.

Maintain accurate case documentation and ensure information is updated throughout the customer and prescription management process.

Collaborate with internal and external stakeholders to resolve complex cases and maintain efficient workflows.

Contribute to continuous process improvement and support a high standard of customer and patient service.

Requirements:

Bachelor’s degree in pharmacy, life sciences, or a related field, or equivalent professional experience.

At least 2 years of experience in pharmacy operations, retail pharmacy, hospital pharmacy, specialty pharmacy, customer service, or a related healthcare environment.

Active pharmacy technician registration or licensure, where required, is preferred.

Strong understanding of prescription processing, insurance requirements, prior authorization workflows, and specialty medication operations.

Strong attention to detail and ability to maintain accurate records while managing multiple cases and priorities.

Ability to investigate and resolve operational, technical, billing, and insurance-related issues.

Strong organizational, problem-solving, and follow-up skills.

Ability to work effectively with pharmacists, pharmacy teams, payers, manufacturers, customers, and other stakeholders.

Comfortable working with pharmacy management systems and other digital tools.

Strong written and verbal communication skills.

Ability to recognize issues requiring escalation and involve the appropriate clinical or operational resources.

Knowledge of regulatory requirements, audit preparation, medication handling, and pharmacy compliance is an advantage.

Self-motivated, reliable, and capable of working effectively in a remote environment.

Commitment to quality, accuracy, confidentiality, and patient-focused service.

Benefits:

Full-time, remote position based in Ontario, Canada.

Comprehensive benefits supporting physical, emotional, financial, and social well-being.

Medical, dental, and vision coverage.

Programs supporting working families, including eligible dependent care and family-building resources.

Adoption assistance and infertility/family-building support.

Behavioral health and wellness resources.

Paid parental leave and paid caregiver leave.

Training and professional development programs.

Mentorship opportunities and access to employee resource groups.

Opportunities to participate in volunteer and community initiatives.

Supportive and inclusive work environment.

Accessibility and reasonable accommodation support throughout the employment process.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

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