Case Manager

Must have

• Strong patient facing experience (phone), role will not meet with patients in person
• Must have pharma, hospital, or insurance industry
• Must have experience with insurance, reimbursement experience
• Strong customer service experience
• MS Office
• Salesforce experience

Nice to Have/ Plus

• Call center experience
• Previous experience with rare/chronic conditions
• Spanish language fluency highly preferred

Job Description:

Hybrid Role

Provide exceptional service to support patients/families starting and continuing therapy by demonstrating empathetic listening skills, care, and commitment. Coordinate between patients/families, healthcare providers, insurance providers, specialty pharmacy and local resources. Conduct benefit investigation, provide patient education, enroll in patient support programs, and coordinate drug delivery. Exceed in delivering a positive patient experience and be the resource of choice for the rare blood community. Be an active cross-functional team member to deliver best-in-class services to ensure access to therapy.

Job Responsibilities:

• Engage patients/families to create a long-term relationship, uncover patient needs, understand challenges, and provide education and support to start or continue therapy. Manage complex issues and utilize approved resources to reduce/remove barriers as needed

• Assist in obtaining insurance approval for therapy, proactively plans for maintenance of coverage by working with the patients/families, healthcare providers, insurance companies and specialty pharmacies

• Enroll patients who qualify in financial assistance or gap coverage

• Educate patients/families and healthcare providers about patient support services. Educate about patient insurance options, limitations, requirements. Connect patients/families with local resources

• Ensure close cross-functional collaboration with Patient Services field teams, Sales, and Market Access as appropriate to ensure consistent integrated approach to supporting patient access

• Establishes and maintains professional and effective relationships with all internal and external customers including but not limited to Patient Services colleagues, Medical, Sales, Market Access, Patient Advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators.

• Represent Client at patient meetings and conferences as the trusted community resource

• Document call details with attention to data integrity to ensure compliance and enhance our service offering

• Leverages CRM reporting tools and data analytics to make strategic decisions about their territory and prioritize patient and customer needs.

• Provide caseload coverage outside of assigned territory as needed.

• Seek coaching feedback to enhance service skills

• Ensure compliance with Client policies

Qualifications:

• Bachelor’s degree required

• Minimum 2-4 years patient-facing role experience in case management, reimbursement, or patient advocacy

• Experience with engaging patients and caregivers with rare/chronic conditions

• Comprehensive understanding of the reimbursement process, billing/coding, insurance plans, payer trends, financial assistance programs, charitable access and related resources

• Excellent phone communication and service-oriented mindset

• Excellent attention to detail and ability to multi-task in a fast-paced environment

• Experience with Salesforce CRM preferred

• Proficient with MS Word, MS Excel, and MS PowerPoint

• Working hours may vary based on business needs and team coverage

• Spanish language fluency highly preferred

This position is based in Cambridge, MA. Remote work available 2 days per week. Hours are 10:30am-7pm EST