Clinical Case Manager, RN / Nurse Ambassador

*As a pharmaceutical support industry leader**, UBC** is devoted to **empowering health solutions for a better tomorrow**. We take **pride** in **improving** patient outcomes and **advancing healthcare.** At UBC we provide services to enhance the entire drug development process and commercialization lifecycle - From clinical trial support to real-world evidence generation.* *Embark on a rewarding **career journey with UBC!** **Grow** your career while making a meaningful **impact** on the **world** around you. **UBC** fosters a culture built on our Core Values being: Collaborative, Conscientious, Curious, Consultative, and Compassionate. We believe in an **inclusive workplace** that fosters creativity.* *If you are seeking a career that will **challenge, inspire,** and **reward** you, join us at **UBC!*** * * * **Please read the role requirements in their entirety before applying.** **Scheduling & Start Date Details:** - **This is a highly telephonic nursing role requiring continuous work within an inbound/outbound call queue along with virtual calls. Nurses must be comfortable spending the majority of their workday on the phone participating in conversations. This is a desk-based position that requires nurses to remain at their workstation throughout the workday. Calls are routed through a computer-based phone system and must be answered directly from the queue. Candidates seeking a flexible, mobile work environment or a role that allows them to be away from their desk for extended periods may not find this position to be a good fit.** - **Work Hours:** Shifts are scheduled within the window of 8:00 AM – 9:00 PM ET. Team members are assigned a 9-hour shift within this range, which includes a 1-hour unpaid lunch break and additional breaks throughout the day. - **Holiday & Weekend Rotation:** This role includes a rotating Saturday shift (9:00 AM – 2:00 PM ET) approximately every 5 weeks. Saturday hours are paid as overtime. Team members may also be required to work select holidays on a rotating basis to support business needs. - **Start Date:** Monday, August 10th, 2026 - **Time Off Policy:** Due to training and onboarding requirements, scheduled time off during training cannot be accommodated. - **Travel:** One week during training (accommodated by the business). * * * **Brief Description**: Performs as a Clinical Case Manager supporting healthcare providers and patients through telephonic support for client funded contracts. This includes: telephonic support to healthcare providers, review of payor specific coverage criteria, completing clinical review of prior authorization and appeal submissions and providing written communication utilizing client approved program resources. This role will build and develop strong customer relationships and support all activities that facilitate patient access. **Specific job duties:** - Adhere to principles as stipulated by program specific contractual agreements and company practices. - Demonstrate clinical competency regarding reimbursement, product, and medical records and will review and train other team members on these concepts. - Troubleshoot complex cases, identify trends (spanning multiple disease-states), investigate data, and resolve escalated issues related to complex reimbursement from both internal and external stakeholders including prior authorization denials and/or appeals. - Perform review of payer product coverage criteria and denial letters for documentation required for submission for coverage determination. - Provide consistent and effective communication with healthcare providers, utilizing approved resources, regarding payer coverage criteria and information that is missing for payor submission. - Professional resource for IB/OB inquiries with focus on data collection, assembling accurate, timely, clear updates and documenting summary of follow up phone calls, patient inquiries, and outcomes including clinical notes and medical record/chart review when applicable.…