Clinical Financial Case Mgr

Scope/Position Summary

The PAC is responsible for follow‑up on all prior authorization submissions and communication to the clinical team regarding the status of the prior authorization. They are also responsible for identifying trends in denials and providing education to clinical staff to reduce these denials, along with gathering all clinical and supporting evidence. The PAC must have a strong understanding of disease implications, use of various treatment modalities, and expected outcomes.

The PAC’s responsibilities include understanding and verifying benefits, obtaining prior authorization for outpatient medications, and collecting and interpreting patient clinical information. In addition, the PAC may be required during the authorization process to contact patients/families to gather information. Communication will also be necessary with physicians, payers, and other customer groups. PACs must navigate the electronic medical record system to obtain and interpret pertinent medical information for the prior authorization process, including determining whether a medication is being used within or outside FDA labeling, relevant lab results, genetic testing, and pathology.

PACs will solve routine customer problems related to prior authorization work.

• Active OH Board of Pharmacy Certified Pharmacy Technician required.
• Associate or bachelor’s degree preferred.
• Minimum of 3 years’ pharmacy experience preferred.
• Experience with Windows, Excel, Access, and intranet/internet navigation tools.
• Knowledge of Medicare and commercial insurance reimbursement, and general knowledge of ICD‑10 codes.
• Excellent verbal and written communication skills required.
• Proficient in computer‑based research and medical record documentation.
• Ability to satisfy expectations of onsite work at an OSUWMC team location facility.

Screen reader users may encounter difficulty with the online application. For assistance with applying, please contact hr-accessible application. If you have questions while submitting an application, please review these FAQs.

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post‑offer process.

The university is an equal opportunity employer, including veterans and disability.

• Entry level

• Full‑time

• Health Care Provider

• Hospitals and Health Care