Case Manager – Rare Disease

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

📋 Description

• Oversee and stay informed on patient customer service matters related to insurance, specialty pharmacy, and patient support initiatives on a daily basis.

• Engage regularly with Regional Business Managers (RBMs), Patient Access Liaison (PAL), and Medical Science Liaisons (MSLs) to ensure timely and precise 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.

• Report Adverse Events (AEs) and product complaints through the medical information department.

• Maintain comprehensive case history for all U.S. patients, documenting pertinent notes from the hub, pharmacy, insurance calls, patient support programs, and interactions with physicians, nurses, patients, and families.

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

• Triage, troubleshoot, and resolve initial and ongoing reimbursement challenges (PAs, 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 alternatives.

• Identify both general and specific adherence patterns and propose suitable actions.

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

• Oversee, track, and report annually on Open Enrollment efforts to guarantee that every patient has access to adequate insurance coverage.

• 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.

• Bachelor’s Degree is strongly preferred.

• Over 5 years of experience in the pharmaceutical sector.

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

• Exceptional communication skills and a strong dedication to customer service.

• Capability to effectively resolve challenges across multiple cases simultaneously.

• Ability to learn product and disease information, with knowledge of HIPAA and FDA regulations.

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

• Proficiency in Excel and PowerPoint is required.

• Willingness to travel up to 20%.

🏝️ Benefits

• Comprehensive employee benefits package, which includes 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 options where feasible.