Case Manager, Reimbursement

Job description

Exciting opportunities await as we launch a groundbreaking new program! We are thrilled to announce we are looking for internal applicants to join our dynamic team! We value your perspective and believe in the power of our internal talent. This program aims to harness the potential within our organization, providing a platform for you to showcase your capabilities, take on new responsibilities, and develop professionally. If you are passionate, driven, and ready to take on new challenges, we encourage you to seize this incredible opportunity. Shape the future, apply today and let your talent shine within 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 in a timely manner, 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.

Desired Skills and Qualifications:

- Bachelor’s degree or six years of relevant working experience

- Two (2) or more years of relevant experience in pharmacy benefit management preferred

- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred

- Certification preferred but not 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

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.