Senior Case Manager, Reimbursement

🕒 Ontem

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟠 Sênior

👔 Gerente

👻 Score fantasma 10%

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• Aberta há 1 dia.
• As vagas desta empresa costumam ser preenchidas em 22 dias.
• Sem salário divulgado.

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UBC

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2003

🏥 Saúde

💼 Consultoria

🧬 Biotecnologia

Healthcare • Consulting • Biotechnology

A UBC é uma empresa dedicada a melhorar os resultados dos pacientes, conectando terapias especializadas aos pacientes que delas necessitam. Eles oferecem soluções modernas e personalizadas, focando em acesso, segurança e geração de evidências para produtos biofarmacêuticos. A UBC é especializada em desenvolvimento de evidências, gestão de riscos e acesso do paciente, utilizando dados do mundo real e tecnologias inovadoras para otimizar a jornada de saúde e garantir o uso eficaz de medicamentos.

Descrição

• Provide day-to-day oversight and coordination of assigned caseload • Ensure case elements and tasks are completed timely and cases move through the process as required • Act as the single point of contact for prior authorization and appeal processing communications • Support patients, healthcare providers, field reimbursement representatives and other external stakeholders • Serve as a patient advocate and resource while coordinating additional patient access services within program guidelines • Perform quality checks on cases and report trends to leadership • Troubleshoot complex cases spanning multiple disease states • Interface with internal and external stakeholders to ensure optimal start to therapy • Act as a point of contact for case managers regarding prior authorization and appeal requirements • Provide guidance, answer process questions and address escalated issues • Support at-risk patients and prescribers to mitigate lapses in therapy • Collaborate with senior case managers, managers and the quality team on monthly quality-trend reviews • Create process improvement initiatives • Prepare and present team huddles and client presentations, with a minimum of one presentation per month • Serve as an account manager for prescribers when needed • Partner with client field teams on best practices, territory trends and escalations • Analyze process quality and efficiency data • Mentor and/or lead other case managers • Ensure operations run smoothly and work in progress meets acceptable standards • Perform other assigned duties

🎯 Requisitos

• 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 • Must comply with applicable company, state and federal safety and environmental programs and procedures • Must report Adverse Drug Events experienced by patients in accordance with pharmaceutical requirements • Must recognize product quality complaints and forward caller/written information to a manufacturer • Must work 11am–8pm EST

🏖️ Benefícios

• Remote opportunities • Competitive salaries • 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 • Telemedicine (Virtual doctor appointments) • Wellness program • Adoption assistance • Short term disability • Long term disability • Life insurance • Discount programs

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