Case Manager, Reimbursement

University of British Columbia; United States; Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Remote opportunities

Growth opportunities

401K match

Tuition reimbursement

Flexible work environment

PTO

Paid Holidays

Employee assistance programs

Medical coverage

Dental coverage

Vision coverage

Job summary

University of British Columbia seeks a Case Manager to oversee daily caseloads, coordinate prior authorizations, and support patients and providers through the reimbursement process.

You will determine eligibility for additional services and liaise with internal/external teams to ensure timely actions and accurate documentation.

Qualifications

• Bachelor’s degree or six years of relevant experience.
• 2+ years of relevant experience in pharmacy benefit management.
• PAP experience preferred.
• Certification preferred but not required.
• Proficient in MS Office applications.
• Knowledge of medical and claims processing terminology.
• Excellent written/verbal communication.
• Salesforce experience preferred.

Responsibilities

• Provide day-to-day oversight and coordination of caseload to ensure all elements are completed timely.
• Single point of contact for prior authorization and appeal communications with patients and providers.
• Communicate patient benefits and responsibilities clearly and accurately.
• Assess and refer patients for special programs/services when appropriate.
• Perform quality checks on cases and report trends to leadership.
• Follow safety, quality, and environmental procedures and standards.
• Troubleshoot complex cases across multiple disease states with stakeholders.
• Report Adverse Drug Events as required.
• Perform other duties as assigned.

Skills

Communication

Multi-tasking

Critical thinking

Verbal communication

Written communication

Salesforce

Microsoft Office

Payer terminology

Education

Bachelor’s degree

Six years experience

Tools

Salesforce

Microsoft 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 (PA P), 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.

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
• Experience in full benefits investigation; PAP experience is 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
• Salesforce experience preferred

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
• Growth opportunities for promotion
• 401K with company match
• Tuition reimbursement
• Flexible work environment
• 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 program

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.

9am - 6pm EST