Senior Case Manager, Reimbursement

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

Senior Case Manager, Reimbursement

Regular Client Services All Virtual Locations, Home Based Position, USA, Remote, US

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improvingpatient outcomes and advancing healthcare.At UBCwe 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 impacton 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!

We are currently seeking Senior Case Manager candidates with a strong background in pharmacy reimbursement hubs - working with Pharmacy Benefit Management, complex reimbursement case management, and the ability to provide top notch customer service to our patients.

Brief Description:

The primary purpose of this position is to provide day-to-day case management oversight and coordination of assigned caseload to ensure parties responsible for tasks are completing them timely, as well as, act as a primary resource for patients, healthcare providers and field reimbursement. The Sr Case Manager is responsible for ensuring the ultimate successful and timely completion of cases to include, but not limited to: prior authorizations, reauthorizations and appeals have accurate documentation of payer information and patient status. The Sr. Case Manager may also serve as the account manager for prescribers providing them updates on patient cases, providing resourceful information as needed and within program guidelines, and serving as an advocate for patients. Additionally, the Sr. Case Manager may interact with a client’s field team to partner on sharing best practices, territory trends, resolve escalations or prescriber related issues. Sr. Case Managers are also integral in the data analysis of process evaluation to include quality and efficiency, and can serve as a mentor and/or lead for other case managers. This role can be client facing and may require presentations on various topics that are related to program education, program improvements or other topics as assigned. Lastly, Sr. Case Managers can serve in a lead capacity to ensure that operations are running smoothly which includes managing work in progress to acceptable standards, and provides mentorship to those case managers who may have opportunities from a productivity or quality perspective.

Specific job duties:

• 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.
• 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 (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.
• 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. Provides support for at-risk patients and prescribers to help mitigate any lapse in the start or continuation of therapy.
• 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.

Desired Skills and Qualifications:

• Bachelor’s degree or six years of relevant working experience
• Five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred
• Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required.
• 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

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
• Growth opportunities for promotion
• 401K with company match
• Tuition reimbursement Flexible work environment
• 20 Days PTO (Paid Time Off)
• Paid Holidays
• Employee assistance programs
• Medical, Dental, and vision coverage
• HSA/FSA
• Wellness program
• Adoption assistance
• Short term disability
• Long term disability
• Life insurance

UBC is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national origin, religion, sexua l 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.