Remote Utilization Review Jobs in Rhode Island (NOW HIRING)

Territory Covers: Includes Connecticut and Rhode Island

This role will be supporting the Respiratory business unit.

Relocation is not offered for this role.

Join Amgen's Mission of Serving Patients

At Amgen, if you feel like you're part of something bigger, it's because you are. Our shared mission-to serve patients living with serious illnesses-drives all that we do.

Since 1980, we've helped pioneer the world of biotech in our fight against the world's toughest diseases. With our focus on four therapeutic areas -Oncology, Inflammation, General Medicine, and Rare Disease- we reach millions of patients each year. Amgen is advancing a broad and deep pipeline of medicines to treat cancer, heart disease, inflammatory conditions, rare diseases, and obesity and obesity-related conditions. As a member of the Amgen team, you'll help make a lasting impact on the lives of patients as we research, manufacture, and deliver innovative medicines to help people live longer, fuller happier lives.

Our award-winning culture is collaborative, innovative, and science based. If you have a passion for challenges and the opportunities that lay within them, you'll thrive as part of the Amgen team. Join us and transform the lives of patients while transforming your career.

Field Reimbursement Manager

What you will do

Let's do this. Let's change the world. In this vital role the Field Reimbursement Manager (FRM) will manage defined accounts within a specified geographic region for Patient Access and Reimbursement. This role involves supporting products by executing the collaborative territory strategic plan. The FRM will ensure an understanding of the reimbursement process, field reimbursement services, and patient support programs. They will also work on patient-level reimbursement issue resolution, requiring knowledge and experience with patient health information (PHI).

• Act as an extension of the HUB, providing live one-on-one coverage support

• Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms

• Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges

• Educate and update healthcare providers (HCPs) on key private and public payer coverage and changes that impact patient product access

• Coordinate access/reimbursement issues with relevant partners, including the HUB

• Provide information to HCPs on how the products are covered under the benefit design (Commercial, Medicare, Medicaid)

• Serve as a payer expert for defined geography and promptly communicate payer changes to key stakeholders

• Offer office education during the access process, including formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution

• Educate offices using approved materials

• Review patient insurance benefit options and alternate funding/financial assistance programs

• Collaborate with other departments to resolve reimbursement issues

Working Conditions:

• 3 days a week in geography for customer appointments, (geography specific)

• General office demands - Remote, Work from Home.

• One to two home office days per week.

• Must be able to travel up to 60-80% via automobile or plane.

• Must have a valid driver's license with a clean driving record.

• Possible long periods of sitting and/or keyboard work.

What we expect of you

We are all different, yet we all use our unique contributions to serve patients. The field reimbursement professional we seek is a collaborator with these qualifications.

Basic Qualifications:

• Doctorate degree OR

• Master's degree and 3 years of customer service and/or leadership experience OR

• Bachelor's degree and 5 years of customer service and/or leadership experience OR

• Associate's degree and 10 years of customer service and/or leadership experience OR

• High school diploma / GED and 12 years of customer service and/or leadership experience

In addition to meeting at least one of the above requirements, you must have experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation or resources. Your managerial experience may run concurrently with the required technical experience referenced above.

Minimum Job Qualifications:

• Minimum two years of experience in public or private third-party access arena or pharmaceutical industry in managed care, clinical support, and/or sales

• Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge

• Proven presentation and facilitation skills

• Strong written and oral communication skills

• Organizational skills and project management experience, including the ability to manage multiple projects

• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings

• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers

• Proven experience with hubs and in-depth knowledge of issues related to billing, coding, and appeals across physician types

• Strong collaboration and ability to lead cross functional partner meetings

• Experience with commercial payers, Medicare plans, and state Medicaid in a geographic region

• Live in the geography or less than 10 miles from the geography border

Preferred Qualifications:

• Bachelor's degree in business, healthcare, or a related field

• Experience with specialty/biologic self-injectable (pharmacy benefit) or physician-administered (buy and bill/medical benefit) products

• Advanced knowledge of medical insurance terminology

• Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part B - for buy & bill products and Part D for Pharmacy products).

• Ability to manage ambiguity and problem-solve

• Ability to manage expenses within allocated budgets

• Strong medical reimbursement experience and/or Specialty Pharmacy and Buy & Bill knowledge

• Proven presentation and facilitation skills

• Strong written and oral communication skills

• Organizational skills and project management experience, including the ability to manage multiple projects

• Strong computer literacy, including Word, Excel, and PowerPoint, and the ability to conduct web-based meetings

• Experience in the healthcare industry, including insurance verification, claim adjudication, physician's offices or clinics, pharmacies, and/or pharmaceutical manufacturers

What you can expect of us

As we work to develop treatments that take care of others, we also work to care for your professional and personal growth and well-being. From our competitive benefits to our collaborative culture, we'll support your journey every step of the way.

The expected annual salary range for this role in the U.S. (excluding Puerto Rico) is $145,471.00 to $196,813.00. Actual salary will vary based on several factors including, but not limited to, relevant skills, experience, and qualifications.

In addition to the base salary, Amgen offers a Total Rewards Plan, based on eligibility, comprising of health and welfare plans for staff and eligible dependents, financial plans with opportunities to save towards retirement or other goals, work/life balance, and career development opportunities that may include:

• A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts

• A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan

• Stock-based long-term incentives

• Award-winning time-off plans

• Flexible work models, including remote and hybrid work arrangements, where possible

Apply now for a career that defies imagination

careers.amgen.com

In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.

Amgen does not have an application deadline for this position; we will continue accepting applications until we receive a sufficient number or select a candidate for the position.

Sponsorship for this role is not guaranteed.

As an organization dedicated to improving the quality of life for people around the world, Amgen fosters an inclusive environment of diverse, ethical, committed and highly accomplished people who respect each other and live the Amgen values to continue advancing science to serve patients. Together, we compete in the fight against serious disease.

Amgen is an Equal Opportunity employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status, or any other basis protected by applicable law.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. Amgen is an Equal Opportunity employer and will consider you without regard to your race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

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