Case Manager, Reimbursement

UBC; Town of Florida (NY); Hybrid; USD 55,000 - 85,000; Full time

Benefits offered by this job

Remote opportunities

Competitive salaries

Growth opportunities for promotion

401K with company match*

Tuition reimbursement

Flexible work environment

Discretionary PTO (Paid Time Off)

Paid Holidays

Employee assistance programs

Medical, Dental, and vision coverage

HSA/FSA

Telemedicine (Virtual doctor appoint­,

Wellness program

Adoption assistance

Short term disability

Long term disability

Life insurance

Discount programs

Job summary

UBC, a pharmaceutical support industry leader, is seeking a Case Manager to oversee day-to-day caseload management, coordinate tasks, and serve as the primary resource for patients, healthcare providers, and field reimbursement. This role supports timely prior authorizations, reauthorizations and appeals, while ensuring accurate payer documentation.

The incumbent will pre-screen for additional services, such as injection programs and patient assistance, and will report to leadership on case

Qualifications

• Bachelor’s degree or six years of relevant working experience.
• Two or more years of PBM experience preferred.
• Certification preferred but not required.
• Proficient in Microsoft Office; knowledge of medical terminology.

Responsibilities

• Provide day-to-day oversight and coordination of caseload to ensure timely completion.
• Serve as single point of contact for prior authorization and appeal communications.
• Communicate patient benefits and responsibility clearly.
• Assess and refer patients for special programs when appropriate.
• Performs quality checks on cases and report trends to leadership.
• Adhere to safety, quality and environmental programs and procedures.
• Troubleshoot complex cases with stakeholders to start therapy.
• Report Adverse Drug Events per regulatory requirements.
• Recognize product quality concerns and forward information to manufacturers.
• Other duties, as assigned.

Skills

Microsoft Office

Medical terminology

Communication skills

Critical thinking

Multi-tasking

Pharmacy benefit management

Education

Bachelor’s degree or six years of relevant working experience

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.

This opportunity requires the successful individual to work a shift pattern of either 9am - 6pm EST or 10am - 7pm EST.

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.

Supervisory Responsibility

N/A

Desired 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 preferred
• 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
• Discretionary 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.