Case Manager – Rare Disease

Role Overview

• Experience day to day oversight and awareness of patient customer service issues with insurance, the specialty pharmacy, and patient support programs
• Daily interaction with Regional Business Managers (RBMs), Patient Access Liaison (PAL) and Medical Science Liaison’s (MSLs) to ensure current and accurate communication on the status of insurance approvals and reauthorizations
• Work closely with RBMs, PALs, the hub, pharmacy, and the patient/family to case manage all steps required to gain access to therapy
• Partner with Safety and Pharmacovigilance (PV). Report Adverse Event (AE)’s and product complaints through medical information
• Maintain case history for all U.S. patients, entering relevant notes from the hub, the pharmacy, calls to insurance, patient support programs, physicians and nurses, and the patients and families
• Maintain and update patient status to track reimbursement and shipping status of U.S. patients
• Triage, troubleshoot and resolve initial and ongoing reimbursement issues (PAs, denials, appeals, reauthorizations, overrides, billing problems)
• Liaise with medical offices as necessary to obtain insurance authorizations
• Counsel patients and family on insurance and reimbursement options
• Identify general and specific adherence trends and suggest appropriate action
• Report on weekly changes in patient status, current adjudication status of all patients, overall reimbursement trends, and any other trends, successes, or roadblocks
• Manage, track, and report on Open Enrollment efforts annually to ensure every patient has access to adequate insurance
• Attend patient meetings, industry conferences and sales meetings

Requirements

• Master’s degree OR Bachelor’s degree and 2 years of Case Management experience
• Or Associate’s degree and 6 years of Case Management experience
• Or High school diploma / GED and 8 years of Case Management experience
• 5+ years of experience in the pharmaceutical industry preferred
• 2+ years prior experience as a Case Manager
• Excellent communication skills and commitment to customer service
• Ability to effectively resolve hurdles across multiple cases at the same time
• Ability to learn product and disease information, familiarity with HIPAA and FDA
• Ability to manage communication with case managers and sales reps across multiple geographies and time zones
• Excel and PowerPoint skills required
• Up to 20% travel required

Benefits

• Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions
• group medical, dental and vision coverage
• life and disability insurance
• 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 and bi-annual company-wide shutdowns
• Flexible work models, including remote work arrangements, where possible