Case Manager, Reimbursement - Evening Shifts

UBC; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote opportunities

401K with company match*

Tuition assistance (after 90 days)

Flexible work environment

Paid Holidays

Medical, Dental, and vision coverage

Job summary

UBC is seeking a Case Manager, Reimbursement for an all-virtual US-based role accepting remote candidates. The position focuses on day-to-day caseload oversight, prior authorizations, reauthorizations, and appeals, ensuring timely patient access.

The candidate should have PBM experience, be able to travel occasionally, and communicate clearly with patients and providers. The role emphasizes collaboration with reimbursement teams, quality checks, and program eligibility assessments, contributing

Qualifications

• Bachelor's degree or 6+ years of relevant experience in PBM.
• 2+ years of relevant experience in pharmacy benefit management preferred.
• Remote position with occasional travel as required.
• Proficient in Microsoft Office and strong written/verbal communication.

Responsibilities

• Provide day-to-day oversight and coordination of caseload to ensure tasks are completed.
• Serve as single point of contact for prior authorization and appeal communications.
• Communicate patient benefits and responsibilities clearly and timely.
• Assess and refer patients for special programs/services when appropriate.
• Perform quality checks on cases and report trends to leadership.
• Adhere to safety, quality, and regulatory requirements in all activities.
• Handle complex cases spanning multiple disease states with stakeholders.
• Document and report adverse drug events as required.

Skills

Communication skills

Critical thinking

Multi-tasking

Microsoft Office

Travel willingness

Medical terminology

Claims processing

Education

Bachelor’s degree

Six years experience

Tools

Microsoft Office Suite

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Case Manager, Reimbursement - Evening Shifts

UBC / PAS / Reimb / Access - WPK Client Services All Virtual Locations, Home Based Position, USA, Remote, US

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improvingpatient outcomes and advancing healthcare.At UBCwe 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 impacton 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!

Case Manager, Reimbursement

This position supports business operations between 11:00AM to 8:00 PM Eastern Time Monday through Friday. Candidates must be available to work a full-time assigned schedule with these hours in order to be considered for this role.

Assigned schedules are determined based on business and client needs. Candidates residing outside of the Eastern Time Zone are welcome to apply but must be able to work their assigned shift based on Eastern Time business hours.

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

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
• Ability to travel as required - This is primarily a remote position; however, occasional travel may be required based on client, business, or training needs. While travel is expected to be infrequent, candidates must be willing and able to travel as needed. Travel requirements may vary depending on the client program and business objectives.

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 assistance (after 90 days of employment)
• Flexible work environment
• 20 days PTO
• Paid Holidays
• Employee assistance programs
• Medical, Dental, and vision coverage
• HSA/FSA
• Wellness program
• Adoption assistance
• Short term disability (after 90 days of employment)
• Long term disability
• Life insurance

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.