Case Manager, Reimbursement

United Biosource Corporation; Oregon; Hybrid; USD 52,000 - 68,000; Full time

Benefits offered by this job

Remote opportunities

Competitive salaries

Growth opportunities for promotion

401K with company match

Tuition reimbursement

Paid Time Off

Paid Holidays

Medical, Dental, and vision coverage

HSA/FSA

Job summary

United Biosource Corporation in the United States seeks a Case Manager to oversee day-to-day caseload, coordinate tasks, and serve as the primary point of contact for patients, providers, and field reimbursement.

You will ensure prior authorizations and appeals are obtained promptly, document payer information accurately, and guide patients to eligible programs, with a focus on quality, compliance, and timely therapy initiation.

Qualifications

• Bachelor's degree or six years of relevant working experience.
• 2+ years of PBM experience.
• Knowledge of medical/claims processing terminology.
• Excellent written and verbal communication skills.

Responsibilities

• Oversee caseload to ensure all elements are completed timely.
• Serve as single point of contact for prior authorization and appeals communications.
• Communicate patient benefits and responsibilities clearly and accurately.
• Refer patients to appropriate special programs/services.
• Perform quality checks and report trends to leadership.
• Ensure compliance with safety, quality, and regulatory programs.

Skills

Communication

Critical thinking

Multi-tasking

MS Office

Education

Bachelor's degree or equivalent experience

Tools

MS Office

Job description

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improving patient outcomes and advancing healthcare. At UBC we provide services to enhance the entire drug development process and commercialization lifecycle - From clinical trial support to real-world evidence generation.Embark on a rewarding career journey with UBC! Grow your career while making a meaningful impact on the world around you. UBC fosters a culture built on our Core Values being: Collaborative, Conscientious, Curious, Consultative, and Compassionate. We believe in an inclusive workplace that fosters creativity.If you are seeking a career that will challenge, inspire, and reward you, join us at UBC!

Brief Description :

The primary purpose of this position is to provide day-to-day case management oversight and coordination of assigned caseload to ensure parties responsible for tasks are completing them timely, as well as act as a primary resource for patients, healthcare providers and field reimbursement. The Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained in a timely manner, as well as ensuring accurate documentation of payer information and patient status. In addition, the Case Manager is responsible for completing a pre-screen to determine eligibility for additional services such as injection services, co-pay mitigation, and patient assistance programs (PAP), if applicable.

Specific job duties:

• Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and ensure cases move through the process as required.
• Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders.
• Communicate patient benefits and responsibility timely and accurately.
• Assess and refer patients appropriately for special programs/services when appropriate.
• Performs quality checks on cases and report trends to leadership.
• Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.
• Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy.
• Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements.
• Recognize a product quality complaint and forward caller/written information to a manufacturer.
• Other duties, as assigned.

Skills and Qualifications:

• Bachelor's degree or six years of relevant working experience
• Two (2) or more years of relevant experience in pharmacy benefit management
• Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
• Certification preferred but not required
• Proficient in MicroSoft Office applications
• Knowledge of medical and claims processing terminology
• Excellent written/verbal communication to include providing clear instructions
• Must possess a strong critical thinking skillset along with the ability to multi-task

Benefits:

At UBC, employee growth and well-being are always at the forefront. We offer an extensive range of benefits to ensure that you have everything you need to thrive personally and professionally. Here are some of the exciting perks UBC offers:

• Remote opportunities
• Competitive salaries
• Growth opportunities for promotion
• 401K with company match
• Tuition reimbursement Flexible work environment
• 20 Days PTO (Paid Time Off)
• Paid Holidays
• Employee assistance programs
• Medical, Dental, and vision coverage
• HSA/FSA
• Telemedicine (Virtual doctor appointments)
• Wellness program
• Adoption assistance
• Short term disability
• Long term disability
• Life insurance
• Discount programs

UBC is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class. We are committed to a diverse, equitable and inclusive culture that fosters respect for each other, our clients, and our patients.

Our hours are 8am-8pm EST; this role will be an 8 hour shift within those hours.