[Hiring] Case Manager @United Biosource Corporation

Role 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.

• 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.
• Perform 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 with pharmaceutical requirements.
• Recognize a product quality complaint and forward caller/written information to a manufacturer.
• Other duties, as assigned.

Qualifications

• Bachelor’s degree or six years of relevant working experience.
• Two (2) or more years of relevant experience in pharmacy benefit management.
• Experience in full benefits investigation; PAP experience is 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.
• Salesforce experience preferred.

Benefits

• Remote opportunities.
• Growth opportunities for promotion.
• 401K with company match.
• Tuition reimbursement.
• Flexible work environment.
• PTO (Paid Time Off).
• Paid Holidays.
• Employee assistance programs.
• Medical, Dental, and vision coverage.
• HSA/FSA.
• Telemedicine (Virtual doctor appointments).
• Wellness program.
• Adoption assistance.
• Short term disability.
• Long term disability.
• Life insurance.
• Discount program.