Senior Reimbursement Case Manager - Remote & Growth

UBC; United States; Remote; USD 95,000 - 125,000; Full time

Benefits offered by this job

Remote opportunities

Growth opportunities for promotion

401K with company match

Tuition reimbursement

Health, dental, vision

Job summary

UBC is seeking a Senior Case Manager, Reimbursement to oversee day-to-day caseload management across PBM and patient support programs. The role emphasizes prior authorizations, appeals, and timely documentation, while serving as a patient advocate and primary contact for providers and field reimbursement.

This remote US position invites collaboration with a cross-functional team, data-driven process improvement, and monthly presentations.

Qualifications

• Bachelor’s degree or six years of relevant working experience.
• Five or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred.
• Three 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.
• Strong critical thinking and ability to multi-task.

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 for prior authorization and appeal communications with patients, providers, field reimbursement reps and external stakeholders.
• Serve as patient advocate and resource for patients navigating the reimbursement process.
• Perform quality checks on cases and report trends to leadership.
• Maintain good housekeeping and ensure quality/production standards in safety and environmental programs.
• Troubleshoot complex cases spanning multiple disease-states with key stakeholders.
• Report Adverse Drug Events per pharmaceutical requirements.
• Provide guidance and escalation support for prescribers and case managers; mentor others.

Skills

PBM experience

Specialty pharmacy

PA/Appeals

Medical assistant exp

MS Office

Medical terminology

Communication

Critical thinking

Education

Bachelor’s degree

Job description

UBC is seeking a Senior Case Manager, Reimbursement to oversee day-to-day caseload management across PBM and patient support programs. The role emphasizes prior authorizations, appeals, and timely documentation, while serving as a patient advocate and primary contact for providers and field reimbursement.

This remote US position invites collaboration with a cross-functional team, data-driven process improvement, and monthly presentations.