Senior Case Manager, Reimbursement

🔥 7 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

👔 Manager

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UBC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

🏥 Healthcare

💼 Consulting

🧬 Biotechnology

Healthcare • Consulting • Biotechnology

UBC is a company dedicated to improving patient outcomes by connecting specialty therapies to patients in need. They provide modern and customized solutions focusing on access, safety, and evidence generation for biopharmaceutical products. UBC specializes in evidence development, risk management, and patient access, utilizing real-world data and innovative technologies to optimize the healthcare journey and ensure effective medication use.

📋 Description

• 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 • Coordinate prior authorization, reauthorization, and appeal processing communications • Serve as a patient advocate and resource during the reimbursement process • Coordinate additional patient access services within program guidelines • Perform quality checks and report trends to leadership • Troubleshoot complex cases across multiple disease states • Interface with internal and external stakeholders to support timely therapy starts • Report Adverse Drug Events according to pharmaceutical requirements • Recognize product quality complaints and forward information to the manufacturer • Support case managers with prior authorization and appeal requirements • Provide guidance, answer process questions, and address escalated issues • Support at-risk patients and prescribers to mitigate therapy delays or interruptions • Collaborate with senior case managers, managers, and the quality team on quality trends and process improvement • Prepare and present team huddles and client presentations, with a minimum of one presentation per month • Mentor or lead case managers and help ensure smooth operations • Perform other duties as assigned

🎯 Requirements

• 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 be able to work 11am-8pm EST

🏖️ Benefits

• 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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