Remote Senior Case Manager – Pharmacy Reimbursement Lead

University of British Columbia; United States; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

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

Job summary

University of British Columbia (UBC) is seeking a Senior Case Manager with a strong background in pharmacy reimbursement hubs to manage day-to-day casework and advocate for patients navigating the reimbursement process. You will coordinate prior authorizations, appeals, and related activities while mentoring colleagues and ensuring high-quality outcomes.

The role involves collaboration with providers and field teams, presentations for client education, and data-driven process improvements.

Qualifications

• Bachelor’s degree or six years of relevant working experience.
• Five or more years of PBM, specialty pharmacy or patient support (HUB) experience preferred.
• Three or more years in pharmacy/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 clear instructions.
• Strong critical thinking and multi-tasking skills.

Responsibilities

• Provide day-to-day oversight and coordination of caseload to ensure tasks are completed timely.
• Act as single point of contact for prior authorization and appeals with patients, providers, and field reps.
• Serve as patient advocate and coordinate access services within program guidelines.
• Perform quality checks on cases and report trends to leadership.
• Maintain good housekeeping and comply with safety and production standards.
• Troubleshoot complex cases across disease-states with stakeholders.
• Report Adverse Drug Events per pharmaceutical requirements.
• Forward product quality concerns to manufacturers.
• Support case managers on prior authorizations/appeals and mentor others.
• Collaborate with senior case managers and quality team on monthly reviews and improvements.
• Prepare and present team huddles and client presentations (min one per month).
• Other duties, as assigned.

Skills

Excellent written/verbal communication

Strong critical thinking

Multi-tasking

Knowledge of medical and claims terms

Proficient in Microsoft Office

Education

Bachelor’s degree or six years of relevant experience

Tools

Microsoft Office

Job description

University of British Columbia (UBC) is seeking a Senior Case Manager with a strong background in pharmacy reimbursement hubs to manage day-to-day casework and advocate for patients navigating the reimbursement process. You will coordinate prior authorizations, appeals, and related activities while mentoring colleagues and ensuring high-quality outcomes.

The role involves collaboration with providers and field teams, presentations for client education, and data-driven process improvements.