Senior Case Manager, Reimbursement

UBC

Sr. Case Manager overseeing case management tasks and ensuring timely completion at UBC health solutions.

Posted 5/21/2026full-timeRemote • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

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 issues 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.

Requirements

What you’ll need

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
Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required.
Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
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.

Benefits

Comp & perks

Remote opportunities
Competitive salaries
Growth opportunities for promotion
401K with company match
Tuition reimbursement
Flexible work environment
20 Days 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 programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

pharmacy benefit managementspecialty pharmacypatient support servicesmedical benefit verificationsprior authorizationappeals processingquality checksadverse drug events reportingproduct quality complaint recognitionprocess improvement initiatives

Soft Skills

communicationcritical thinkingmulti-taskingpatient advocacycollaborationpresentation skillsguidanceproblem-solvingleadershiporganizational skills

Certifications

Bachelor's degreeMedical AssistantSocial WorkerSenior Reimbursement Specialist