Case Manager, Reimbursement

United Biosource Corporation• Remote, US,

2d•Remote

About The Position

The Case Manager provides day-to-day oversight and coordination of an assigned caseload, ensuring that case elements and tasks are completed on time and that cases progress through the required process. The role serves as a primary resource and single point of contact for patients, healthcare providers, field reimbursement representatives, and other external stakeholders regarding prior authorizations and appeals. The Case Manager ensures that prior authorizations, reauthorizations, and appeals are obtained promptly; communicates patient benefits and financial responsibility accurately; and documents payer information and patient status correctly. The Case Manager also pre-screens patients for eligibility for additional services, such as injection services, co-pay mitigation, and patient assistance programs, when applicable. The position involves quality checks, identifying and reporting trends, troubleshooting complex cases across multiple disease states, and coordinating with internal and external stakeholders to support timely starts to therapy. The role also requires reporting adverse drug events according to pharmaceutical requirements and forwarding product quality complaints to manufacturers.

Requirements

Bachelor’s degree or six years of relevant work experience.
Proficiency in Microsoft Office applications.
Knowledge of medical and claims-processing terminology.
Excellent written and verbal communication skills, including the ability to provide clear instructions.
Strong critical-thinking skills and the ability to multitask.

Nice To Haves

Two or more years of relevant experience in pharmacy benefit management preferred.
Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist preferred.
Certification preferred but not required.

Responsibilities

Provide day-to-day oversight and coordination of an assigned caseload to ensure case elements and tasks are completed on time and cases move through the process as required.
Serve as the single point of contact for prior authorization and appeal processing communications with patients, healthcare providers, field reimbursement representatives, and other external stakeholders.
Communicate patient benefits and financial responsibility accurately and promptly.
Pre-screen patients and refer them to appropriate additional programs or services when applicable, including injection services, co-pay mitigation, and patient assistance programs.
Perform quality checks on cases and report trends to leadership.
Follow good housekeeping techniques and adhere to quality and production standards, as well as applicable company, state, and federal safety and environmental programs and procedures.
Troubleshoot complex cases spanning multiple disease states and coordinate with internal and external stakeholders to support an optimal start to therapy.
Report adverse drug events experienced by patients in accordance with pharmaceutical requirements.
Recognize product quality complaints and forward caller or written information to a manufacturer.
Perform other duties as assigned.