Remote Case Manager, Reimbursement & Appeals

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 assistance

Job summary

UBC is seeking a Case Manager, Reimbursement to oversee day-to-day caseload management and coordinate prior authorizations, reauthorizations, and appeals. This role supports patients, healthcare providers, and field reimbursement teams, ensuring timely documentation and eligibility screening for additional services.

The position requires a Bachelor's degree or equivalent experience, with 2+ years in pharmacy benefit management and strong communication and Microsoft Office skills.

Qualifications

• Bachelor's degree or six years of relevant working experience.
• Two or more years of relevant experience in pharmacy benefit management 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.

Responsibilities

• Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely.
• 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 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

Microsoft Office

Medical terminology

Communication

Critical thinking

Multi-tasking

Travel readiness

Education

Bachelor's degree

Six years of relevant experience

Job description

UBC is seeking a Case Manager, Reimbursement to oversee day-to-day caseload management and coordinate prior authorizations, reauthorizations, and appeals. This role supports patients, healthcare providers, and field reimbursement teams, ensuring timely documentation and eligibility screening for additional services.

The position requires a Bachelor's degree or equivalent experience, with 2+ years in pharmacy benefit management and strong communication and Microsoft Office skills.