Case Manager, Reimbursement

As a pharmaceutical support industry leader , UBC is devoted to empowering health solutions for a better tomorrow . We take pride in improving patient 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 impact on 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!

Case Manager, Reimbursement

Shifts: This position supports business operations between 8:00 AM and 9:00 PM Eastern Time . Candidates must be available to work a full-time assigned shift within these hours. Examples of potential schedules include:

- 8:00 AM – 5:00 PM ET

- 9:00 AM – 6:00 PM ET

- 10:00 AM – 7:00 PM ET

- 11:00 AM – 8:00 PM ET

- 12:00 PM – 9:00 PM ET

Assigned schedules are determined based on business and client needs. Candidates residing outside of the Eastern Time Zone are welcome to apply but must be able to work their assigned shift based on Eastern Time business hours.

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 Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained in a timely manner, as well as ensuring accurate documentation of payer information and patient status. In addition, the Case Manager is responsible for completing a pre-screen to determine eligibility for additional services such as injection services, co-pay mitigation, and patient assistance programs (PAP), if applicable.

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.

- 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 (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.

- Other duties, as assigned

Desired Skills and Qualifications:

- Bachelor’s degree or six years of relevant working experience

- Two (2) or more years of relevant experience in pharmacy benefit management preferred

- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience 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 req