Clinical Case Manager, RN

United Biosource Corporation• Remote, US,

1d•Remote

About The Position

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!

Requirements

Minimum- associate degree and professional nursing license
Registered Nurse License in good standing in the state in which you work, telephonic clinical roles are required to have a Compact State License in eligible states; additionally, employee must be willing to obtain Compact State license at such time as their state elects to adopt Compact legislation
Telephonic clinical roles are required to have a California State License and the employee must be willing to obtain additional Single State Licenses upon request.
Previous experience in the PBM and/or healthcare industry
Competent ability to research, analyze, prepare reports, and document clearly
2+ years’ experience in a customer service setting demonstrating advanced skills in issue resolution, preferably in a call center environment
Proficient in Microsoft Office applications, specifically Excel
Ability to handle a fast-paced environment and multi-tasking
Strong written and verbal communication skills
Advanced problem solving and trouble-shooting skills including critical thinking
Strong attention to detail and relationship building skills and the ability to train other team members

Responsibilities

Performs as a Clinical Case Manager supporting healthcare providers and patients through telephonic support for client funded contracts.
Provides telephonic support to healthcare providers, reviews payor specific coverage criteria, completes clinical review of prior authorization and appeal submissions, and provides written communication utilizing client approved program resources.
Builds and develops strong customer relationships and supports all activities that facilitate patient access.
Adheres to principles as stipulated by program specific contractual agreements and company practices.
Demonstrates clinical competency regarding reimbursement, product, and medical records and will review and train other team members on these concepts.
Troubleshoots complex cases, identifies trends (spanning multiple disease-states), investigates data, and resolves escalated issues related to complex reimbursement from both internal and external stakeholders including prior authorization denials and/or appeals.
Performs review of payer product coverage criteria and denial letters for documentation required for submission for coverage determination.
Provides consistent and effective communication with healthcare providers, utilizing approved resources, regarding payer coverage criteria and information that is missing for payor submission.
Acts as a professional resource for IB/OB inquiries with focus on data collection, assembling accurate, timely, clear updates and documenting summary of follow up phone calls, patient inquiries, and outcomes including clinical notes and medical record/chart review when applicable.
Gathers, analyzes, and prepares data for Quarterly Business Reviews (QBRs) and/or client meetings.
Participates in program specific customer meetings and training sessions.
Reports Adverse Drug Events that have been experienced by the patient in accordance with manufacturer requirements.
Attends manufacturer hosted conferences, customer meetings/training, and QBRs as requested (including requests to travel for in-person attendance).
Completes special projects and other duties as assigned.