Pharmaceutical Support RN (Remote 11:00 AM-8:00 PM or 12:00)

University of British Columbia; United States; Remote; USD 75,000 - 95,000; Full time

Benefits offered by this job

Remote opportunities

Competitive salaries

Growth opportunities

401K with company match

Tuition reimbursement

20 days PTO

Paid Holidays

Employee assistance programs

Medical, Dental, and vision coverage

HSA/FSA

Telemedicine /Virtual doctor visits

Wellness program

Adoption assistance

Short term disability

Long term disability

Life insurance

Discount programs

Job summary

UBC is seeking a Clinical Case Manager to support healthcare providers and patients via telephonic care for client-funded contracts. You will review coverage criteria, handle prior authorizations and appeals, and provide written communications using approved resources.

Build strong customer relationships and support patient access. The role requires RN licensure, compact licenses where applicable, and California licensure endorsement upon hire.

Qualifications

• Associate degree and RN license required.
• Compact State License in eligible states; willing to obtain CA licensure upon hire.
• Experience in PBM/healthcare industry preferred.
• Strong research, analysis, and documentation skills.
• 2+ years in a customer service/call center environment.
• Proficient in Microsoft Excel; strong written and verbal communication.

Responsibilities

• Adhere to program agreements and company practices.
• Demonstrate clinical competency in reimbursement and medical records.
• Troubleshoot complex reimbursement cases and appeals.
• Review payer coverage criteria and documentation for submissions.
• Communicate clearly with healthcare providers and clients.
• Document follow-up interactions and clinical notes.
• Gather data for Quarterly Business Reviews and client meetings.
• Attend customer meetings and training sessions.
• Report adverse events per manufacturer requirements.
• Travel for trainings and client meetings as requested.
• Undertake special projects as assigned.

Skills

Verbal communication

Written communication

Problem solving

Multitasking

Attention to detail

Education

Associate degree

Tools

Excel

Job description

This position is offered fully Home based (Remote) 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!Please read the role requirements in their entirety before applying.

Scheduling & Start Date Details

• This is a highly telephonic nursing role requiring continuous work within an inbound/outbound call queue along with virtual calls. Nurses must be comfortable spending the majority of their workday on the phone participating in conversations. This is a desk-based position that requires nurses to remain at their workstation throughout the workday.Calls are routed through a computer-based phone system and must be answered directly from the queue. Candidat es seeking a flexible, mobile work environment or a role that allows them to be away from their desk for extended periods may not find this position to be a good fit.
• UBC provides a desktop computer system, not a laptop. This role is designed to be performed from a dedicated home office or HIPAA-compliant workspace and is not intended for mobile or travel-based work.
• Work Hours:The anticipated schedule is 11:00 AM-8:00 PM ET or 12:00 PM-9:00 PM ET and employees should expect to remain on their assigned shift based on business needs. Schedule changes cannot be guaranteed and opportunities to move to earlier shifts may be limited or unavailable.
• Weekend Rotation: This role includes a rotating Saturday shift (9:00 AM – 2:00 PM ET) approximately every 5 weeks. Saturday hours are paid as overtime. Team members may also be required to work select holidays on a rotating basis to support business needs.
• Due to the extensive onboarding and training process, no planned time off can be accommodated during the 8-week training period.
• Travel: One week of travel during training (business-paid). In addition, occasional travel may be required throughout the year for training, client meetings, conferences, team meetings, or other business-related events.
• Licensing: Registered Nurse license in good standing in your state of residence; candidates must hold or be eligible to obtain a Compact Nursing License (where applicable), obtain and maintain a California RN license through endorsement upon hire, and be willing to obtain additional state licenses as required. All licensing and renewal costs are the employee's responsibility.
• Start Date: 11/9/26

Brief Description

Performs as a Clinical Case Manager supporting healthcare providers and patients through telephonic support for client funded contracts. This includes: telephonic support to healthcare providers, review of payor specific coverage criteria, completing clinical review of prior authorization and appeal submissions and providing written communication utilizing client approved program resources. This role will build and develop strong customer relationships and support all activities that facilitate patient access.

Specific Job Duties

• Adhere to principles as stipulated by program specific contractual agreements and company practices.
• Demonstrate clinical competency regarding reimbursement, product, and medical records and will review and train other team members on these concepts.
• Troubleshoot complex cases, identify trends (spanning multiple disease-states), investigate data, and resolve escalated issues related to complex reimbursement from both internal and external stakeholders including prior authorization denials and/or appeals.
• Perform review of payer product coverage criteria and denial letters for documentation required for submission for coverage determination.
• Provide consistent and effective communication with healthcare providers, utilizing approved resources, regarding payer coverage criteria and information that is missing for payor submission.
• Professional resource for IB/OB inquiries with focus on data collection, assembling accurate, timely, clear updates and documenting summary of follow up phone calls, patient inquiries, and outcomes including clinical notes and medical record/chart review when applicable.
• Gathers, analyzes, and prepares data for Quarterly Business Reviews (QBRs) and/or client meetings.
• Participates in program specific customer meetings and training sessions.
• Report Adverse Drug Events that have been experienced by the patient in accordance with manufacturer requirements.
• Attend manufacturer hosted conferences, customer meetings/training, and QBRs as requested (including requests to travel for in-person attendance).
• Special projects and other duties as assigned.

Desired Skills And Qualifications

• Minimum- associate degree and professional nursing license
• Registered Nurse License in good standing in the state in which you work, telephonic clinical roles are required to have a Compact State License in eligible states; additionally, employee must be willing to obtain Compact State license at such time as their state elects to adopt Compact legislation
• Telephonic clinical roles are required to have a California State License and the employee must be willing to obtain additional Single State Licenses upon request. Upon accepting the offer, candidate is expected to initiate the California licensure by applying through their California licensure endorsement process. All associated fees for applying for and maintaining the CA license and other licensing are the employee’s responsibility.
• Previous experience in the PBM and/or healthcare industry
• Competent ability to research, analyze, prepare reports, and document clearly
• 2+ years’ experience in a customer service setting demonstrating advanced skills in issue resolution, preferably in a call center environment
• Proficient in Microsoft Office applications, specifically Excel
• Ability to handle a fast-paced environment and multi-tasking
• Strong written and verbal communication skills
• Advanced problem solving and trouble-shooting skills including critical thinking
• Strong attention to detail and relationship building skills and the ability to train other team members

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 (after 90 days of employment)
• 20 days PTO
• Paid Holidays
• Employee assistance programs
• Medical, Dental, and vision coverage
• HSA/FSA
• Telemedicine /Virtual doctor appointments
• Wellness program
• Adoption assistance
• Short term disability (after 90 days of employment)
• 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.