Case Manager, Reimbursement

United Biosource Corporation• Remote, US,

7d•Remote

About The Position

The Case Manager, Reimbursement provides day-to-day oversight and coordination of an assigned caseload, ensuring case tasks are completed on time and cases progress as required. 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 timely and accurate communication of patient benefits and responsibilities, and conducts pre-screens to determine eligibility for additional services such as injection services, co-pay mitigation, and patient assistance programs when applicable. The position also involves troubleshooting complex cases across multiple disease states, coordinating with internal and external stakeholders to support timely therapy starts, conducting case quality checks, identifying trends for leadership, reporting adverse drug events, and forwarding product quality complaints to manufacturers. The role follows applicable quality, production, safety, and environmental standards.

Requirements

Bachelor’s degree or six years of relevant working experience.
Two or more years of relevant experience in pharmacy benefit management.
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

Medical Assistant, Social Worker, or Senior Reimbursement Specialist experience preferred.
Certification preferred but not required.

Responsibilities

Provide day-to-day oversight and coordination of assigned caseload to ensure all case elements and tasks are completed timely and cases move through the process as required.
Act as the single point of contact for communications concerning prior authorization and appeal processing with patients, healthcare providers, field reimbursement representatives, and other external stakeholders.
Communicate patient benefits and responsibilities timely and accurately.
Assess and refer patients to appropriate special programs or services when appropriate.
Perform quality checks on cases and report trends to leadership.
Adhere to good housekeeping techniques, quality and production standards, and applicable company, state, and federal safety and environmental programs and procedures.
Troubleshoot complex cases spanning multiple disease states, working with internal and external stakeholders to support an optimal start to therapy.
Report patient adverse drug events in accordance with pharmaceutical requirements.
Recognize product quality complaints and forward caller or written information to a manufacturer.
Perform other duties as assigned.