Sr. Case Manager, Reimbursement

United Biosource Corporation• Remote, US,

6d•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! We are currently seeking Sr. Case Manager candidates with a strong background in pharmacy reimbursement hubs - working with Pharmacy Benefit Management, complex reimbursement case management, and the ability to provide top notch customer service to our patients.

Requirements

Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required.
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

Nice To Haves

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
Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred

Responsibilities

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.
Serve as a patient advocate and resource for patients as they navigate through the reimbursement process while coordinating any additional patient access services within program guidelines.
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.
Act as point of contact for case managers to assist with prior authorization and appeal requirements, provide guidance, answer process questions and address escalated issued when appropriate. Provides support for at-risk patients and prescribers to help mitigate any lapse in the start or continuation of therapy.
Collaborates with other senior case managers, managers and quality team on a monthly basis to review quality trends, creating process improvement initiatives for the next month.
Prepares and presents team huddles, and client presentations as deemed appropriate (minimum one presentation per month).
Other duties, as assigned.