Case Manager – Rare Disease

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Oversee daily patient customer service issues related to insurance, specialty pharmacy, and patient support programs.

• Engage daily with Regional Business Managers (RBMs), Patient Access Liaison (PAL), and Medical Science Liaisons (MSLs) to ensure timely and accurate communication regarding the status of insurance approvals and reauthorizations.

• Collaborate closely with RBMs, PALs, the hub, pharmacy, and patients/families to manage all necessary steps for therapy access.

• Partner with Safety and Pharmacovigilance (PV) to report Adverse Events (AEs) and product complaints through medical information channels.

• Maintain comprehensive case histories for all U.S. patients, documenting relevant notes from the hub, pharmacy, insurance calls, patient support programs, medical professionals, and families.

• Update and track patient status to monitor reimbursement and shipping progress for U.S. patients.

• Triage, troubleshoot, and resolve initial and ongoing reimbursement challenges (prior authorizations, denials, appeals, reauthorizations, overrides, billing issues).

• Coordinate with medical offices as needed to secure insurance authorizations.

• Provide guidance to patients and families regarding insurance and reimbursement options.

• Identify both general and specific adherence trends, recommending suitable actions.

• Report weekly on changes in patient status, current adjudication of all patients, overall reimbursement trends, and any notable trends, successes, or obstacles.

• Manage, track, and report on annual Open Enrollment efforts to ensure all patients have access to sufficient insurance.

• Participate in patient meetings, industry conferences, and sales meetings.

⛳️ Requirements

• Master’s degree OR Bachelor’s degree with 2 years of Case Management experience.

• Alternatively, an Associate’s degree with 6 years of Case Management experience.

• Or a High school diploma/GED with 8 years of Case Management experience.

• Preferred: 5+ years of experience in the pharmaceutical industry.

• At least 2 years of prior experience as a Case Manager.

• Outstanding communication skills and a strong commitment to customer service.

• Capability to effectively resolve challenges across multiple cases simultaneously.

• Ability to absorb product and disease information; familiarity with HIPAA and FDA regulations.

• Proficiency in managing communication with case managers and sales representatives across various geographies and time zones.

• Proficient in Excel and PowerPoint.

• Willingness to travel up to 20% of the time.

🏝️ 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.

• 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 feasible.