Job Description

BASIC QUALIFICATIONS:

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

PREFERRED QUALIFICATIONS:

• Bachelor’s Degree strongly preferred
• 5+ years of experience in the pharmaceutical industry
• 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

• 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 meeting