Remote Case Manager – Pharmacy Benefits & Patient Support

UBC; Oregon; Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Remote opportunities

Competitive salaries

Growth opportunities for promotion

401K with company match

Tuition reimbursement Flexible work环境

20 Days PTO (Paid Time Off)

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 Case Manager to provide day-to-day oversight of assigned caseload, ensuring timely completion of tasks and coordination with patients, providers and field reimbursement. The role involves managing prior authorizations, reauthorizations and appeals, plus determining eligibility for additional services such as injection services and PAP programs.

The ideal candidate has a Bachelor’s degree or equivalent experience, 2+ years in pharmacy benefit management, and strong communication

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

Responsibilities

• 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

Attention to detail

Excellent communication

Multi-tasking

Medical terminology

Payer knowledge

Microsoft Office

Education

Bachelor's degree or six years of relevant experience

Certification preferred but not required

Medical Assistant / Social Worker / Senior Reimbursement Specialist experience

Tools

Microsoft Office

Job description

UBC is seeking a Case Manager to provide day-to-day oversight of assigned caseload, ensuring timely completion of tasks and coordination with patients, providers and field reimbursement. The role involves managing prior authorizations, reauthorizations and appeals, plus determining eligibility for additional services such as injection services and PAP programs.

The ideal candidate has a Bachelor’s degree or equivalent experience, 2+ years in pharmacy benefit management, and strong communication