Remote Senior Case Manager, Pharmacy Reimbursement

United-Biosource-Corporation; United States; A distancia; USD 70.000 - 100.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote opportunities

Growth opportunities for promotion

401K with company match

Tuition reimbursement

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

Long term disability

Life insurance

Descripción de la vacante

United-Biosource-Corporation (UBC) seeks a Senior Case Manager, Reimbursement to oversee day-to-day caseloads, coordinate prior authorizations and appeals, and serve as the patient advocate in a fully remote setting.

You will collaborate with Pharmacy Benefit Management teams, field reimbursement staff, and providers to ensure timely, quality outcomes while mentoring other case managers.

Formación

• Bachelor’s degree or six years of relevant working experience.
• 5+ years of experience in pharmacy benefit management, specialty pharmacy or patient support (HUB) services.
• 3+ years of experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals.
• Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred.
• 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.

Responsabilidades

• 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.
• Serve as a patient advocate and resource for patients as they navigate through the reimbursement process while coordinating any additional patient access services within program guidelines.
• 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.
• Act as point of contact for case managers to assist with prior authorization and appeal requirements, provide guidance, answer process questions and address escalated issued when appropriate.
• Collaborates with other senior case managers, managers and quality team on a monthly basis to review quality trends, creating process improvement initiatives for the next month.
• Prepares and presents team huddles, and client presentations as deemed appropriate (minimum one presentation per month)
• Other duties, as assigned.

Conocimientos

Microsoft Office

Medical terminology

Written communication

Verbal communication

Critical thinking

Multitasking

Educación

Bachelor’s degree

Descripción del empleo

United-Biosource-Corporation (UBC) seeks a Senior Case Manager, Reimbursement to oversee day-to-day caseloads, coordinate prior authorizations and appeals, and serve as the patient advocate in a fully remote setting.

You will collaborate with Pharmacy Benefit Management teams, field reimbursement staff, and providers to ensure timely, quality outcomes while mentoring other case managers.