Case Manager - Rare Disease- TEPEZZA - US Remote

Role Summary

In this vital role the Case Manager will oversee day-to-day patient customer service issues with insurance, the specialty pharmacy, and patient support programs, and will work to ensure access to therapy for U.S. patients. This role collaborates with Regional Business Managers (RBMs), Patient Access Liaison (PAL), and Medical Science Liaisons (MSLs) to ensure current and accurate communication on insurance approvals and reauthorizations.

Responsibilities

• Daily interaction with Regional Business Managers (RBMs), Patient Access Liaison (PAL) and Medical Science Liaisons (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
• Attend patient meetings, industry conferences and sales meetings

Qualifications

• Required: Master’s degree
• Required: Bachelor’s degree and 2 years of Case Management experience
• Required: Associate’s degree and 6 years of Case Management experience
• Required: High school diploma / GED and 8 years of Case Management experience
• Preferred: Bachelor’s Degree strongly preferred
• Preferred: 5+ years of experience in the pharmaceutical industry
• Preferred: 2+ years prior experience as a Case Manager
• Preferred: Excellent communication skills and commitment to customer service
• Preferred: Ability to effectively resolve hurdles across multiple cases at the same time
• Preferred: Ability to learn product and disease information, familiarity with HIPAA and FDA
• Preferred: Ability to manage communication with case managers and sales reps across multiple geographies and time zones
• Preferred: Excel and PowerPoint skills required
• Preferred: Up to 20% travel required