Case Manager, Reimbursement

UBC

. Provide day-to-day case management oversight and coordination of assigned caseload .

Posted 10/31/2026full-timeRemote • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management oversight and coordination, ensuring timely processing of patient cases while effectively communicating with stakeholders. Proficient in medical terminology and claims processing, with strong critical thinking and multitasking abilities.

Highest-signal resume keywords

Case Management OversightPharmacy Benefit ManagementMedical Terminology KnowledgeExcellent Written/Verbal CommunicationCritical Thinking Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementMedical Claims ProcessingQuality ChecksAdverse Drug Events ReportingTroubleshooting Complex CasesPatient Benefit CommunicationMicrosoft Office Proficiency

Soft Skills

Strong CommunicationMulti-tasking Ability

Certifications & Qualifications

Medical Assistant CertificationSocial Worker CertificationSenior Reimbursement Specialist Certification

Industry Keywords

Pharmacy Benefit ManagementPatient Care CoordinationQuality AssuranceHealthcare ComplianceEnvironmental Safety Programs

About the role

Key responsibilities & impact

Provide day-to-day case management oversight and coordination of assigned caseload
Ensure case elements and tasks are completed timely and cases move through the required process
Act as the primary contact for prior authorization and appeal processing communications
Communicate patient benefits and responsibility accurately and promptly
Assess and refer patients for special programs and services
Perform quality checks on cases and report trends to leadership
Troubleshoot complex cases across multiple disease states
Interface with internal and external stakeholders to support optimal start to therapy
Report patient-experienced Adverse Drug Events according to pharmaceutical requirements
Recognize product quality complaints and forward caller or written information to the manufacturer
Maintain good housekeeping techniques and adhere to quality and production standards
Perform 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
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
Strong critical thinking skillset
Ability to multi-task
Must be available to work a full-time assigned schedule between 11:00 AM and 8:00 PM Eastern Time, Monday through Friday
Candidates outside the Eastern Time Zone must be able to work the assigned shift based on Eastern Time business hours
Must be willing and able to travel as needed
Must comply with applicable company, state, and federal safety and environmental programs and procedures

Benefits

Comp & perks

Remote opportunities
Competitive salaries
Growth opportunities for promotion
401K with company match
Tuition assistance (after 90 days of employment)
Flexible work environment
20 days PTO
Paid Holidays
Employee assistance programs
Medical, Dental, and vision coverage
HSA/FSA
Telemedicine (Virtual doctor appointments)
Wellness program
Adoption assistance
Short term disability (after 90 days of employment)
Long term disability
Life insurance
Discount programs
Occasional travel may be required based on client, business, or training needs