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 UBC we 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!

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 timely, 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.

Minimum Qualifications:

• Bachelor's degree in healthcare administration, business administration, or related field
• 2+ years of experience in healthcare reimbursement and pharmacy benefit management
• Experience with Medicare and Medicaid reimbursement
• Excellent communication and organizational skills
• Must possess a strong critical thinking skillset along with the ability to multi-task
• Knowledge of medical and claims processing terminology
• Ability to work independently and manage multiple priorities
• Proficiency in Microsoft Office and other relevant software

Preferred Qualifications:

• Master's degree in healthcare administration, business administration, or related field
• Experience with electronic health records (EHR) and medical billing software
• Certification in healthcare reimbursement (e.g. CRC, CHRS)

Note: 

As a Case Manager, Reimbursement, you will use your excellent communication and organizational skills to manage the reimbursement process for our clients. You will need to be proficient in Microsoft Office and other relevant software to maintain accurate records and communicate effectively with healthcare providers, patients, and insurance companies. Your ability to work independently and manage multiple priorities will be essential to your success in this role. Qualifications such as experience with Medicare and Medicaid reimbursement, electronic health records (EHR) and medical billing software, and certification in healthcare reimbursement (e.g. CRC, CHRS) will be beneficial in performing your duties effectively.  Must be experienced with end-to-end case management experience while providing that "white glove" experience.

Benefits:

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

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

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