Case Manager – Reimbursement

UBC

Reimbursement Case Manager acting as a patient advocate in the pharmaceutical industry. Coordinating patient access to therapies and providing support services for specialty pharmaceuticals.

Posted 6/27/2026full-timeRemote • North Carolina • 🇺🇸 United StatesJuniorMid-LevelWebsite

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
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.

Requirements

What you’ll need

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
Proficient in Microsoft Office applications
Knowledge of medical and claims processing terminology
Excellent written/verbal communication to include providing clear instructions

Benefits

Comp & perks

Remote opportunities
Competitive salaries
Growth opportunities for promotion
401k with company match*
Tuition reimbursement
Flexible work environment
20 Days PTO Annually (accrued)
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

case managementprior authorizationappeal processingquality checkstroubleshootingadverse drug event reportingmedical terminologyclaims processing

Soft Skills

communicationcoordinationattention to detailproblem-solvinginterpersonal skills

Certifications

Bachelor's degreeMedical AssistantSocial WorkerSenior Reimbursement Specialist