Patient Services Case Manager

Proclinical is currently recruiting for a Patient Services Case Manager for a leading biopharmaceutical company located in Waltham, MA. As the Patient Services Case Manager, you will act as the primary point of contact and voice regarding the patient services hub program, handling inbound and outbound communications for all patient and healthcare provider (HCP) interactions

Job Responsibilities:

• Maintains comprehensive understanding of the pharmacy benefit/reimbursement process, billing nuances, insurance plans, payer trends, financial assistance programs, charitable access, and related resources.
• Assists in obtaining insurance approval for therapy, and proactively plans to mitigate delays in coverage by working with the patients and caregivers, healthcare providers, insurance companies, and specialty pharmacies.
• Serves as an advocate for the patients, HCPs, and caregivers throughout the tenapanor journey.
• Educates patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate therapy, case management services and relevant disease/product information as necessary.
• Processes all Patient Assistance Program (PAP) requests in a timely fashion as well as PAP re-approval verification for continued eligibility.
• Is cross-trained to perform various administrative services, including but not limited to, case creation, data entry, benefit investigations/verification for patients, prior authorization and appeals support, and commercial copay benefit design application.

Skills and Requirements:

• B.S. preferred; An Associate Degree or equivalent from a two-year college or technical school plus 5+ years' relevant experience will be considered.
• Prior 3+ years' experience in specialty pharmacy, hub reimbursement services, social work, dietary science, or a related field.
• Direct experience with nephrology products or providers preferred.
• Self-motivated, high degree of initiative, high achievement and superb attention to detail.
• Strong verbal and written communications skills and a demonstrated ability to present clearly and persuasively.
• Ability to independently manage case load and prioritize work. Must have strong time management skills in order manage deliverables while maintaining meticulous attention to detail.
• General knowledge of HCP office processes regarding patient flow, prescription flow and clinic office operations.
• Outstanding customer service, interpersonal, and communication skills with the established ability to build productive internal/external working relationships
• Ability to exhibit a leadership role within the assigned territory and uphold core values (dedicated, fearless, passionate, and inclusive).
• Strong compliance mindset, demonstrating clear understanding of all patient privacy laws
• Prior experience working with CRM system(s).
• Ability to proficiently use Microsoft Excel, Outlook and Word.
• Desire to work in a fast-paced "roll up the sleeves" environment.
• Must be authorized to work in the U.S. for any employer without the need for sponsorship.

If you are having difficulty in applying or if you have any questions, please contact Emily Notman at (+1) 617-963-0344 or e.notman@proclinical.com.

Proclinical is a specialist employment agency and recruitment business, providing job opportunities within major pharmaceutical, biopharmaceutical, biotechnology and medical device companies.

Proclinical Staffing is an equal opportunity employer.

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