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In this vital role the Case Manager will experience day to day oversight and awareness of patient customer service issues with insurance, the specialty pharmacy, and patient support programs.
Job Responsibility:
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
Advise patients and families on insurance, financial assistance and therapeutic access programs
Attend patient meetings, industry conferences and sales meetings
Requirements:
Master’s degree
Bachelor’s degree and 2 years of Case Management experience
Associate’s degree and 6 years of Case Management experience
High school diploma / GED and 8 years of Case Management experience
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
Nice to have:
Bachelor’s Degree strongly preferred
5+ years of experience in the pharmaceutical industry
2+ years prior experience as a Case Manager
What we offer:
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 and bi-annual company-wide shutdowns
Flexible work models, including remote work arrangements, where possible