Patient Navigator

Role Summary

Patient Navigator based in Foster City, CA or Charlotte, NC (hybrid work policy). Serves as the primary liaison for patients, caregivers, and healthcare providers, ensuring a seamless experience from prescription to ongoing therapy. Provides inbound and outbound support and coordinates with the Patient Support Program and specialty pharmacy to help patients receive medications on time. Works with cross-functional teams to support patient access, reimbursement, and program outcomes.

Responsibilities

• Serve as the main point of contact for patients and caregivers, providing non-clinical guidance and emotional support throughout their treatment journey with an understanding of disease state and Mirum product profiles.
• Provide patients and healthcare professionals a clear understanding of eligibility, program enrollment, reimbursement process, affordability support, and general access for Mirum prescribed therapies.
• Deliver high-quality customer service while serving as a brand advocate and program representative; understand the importance of outcomes and appropriate use of resources.
• Coordinate care between prescribers, specialty pharmacies, and insurance providers to ensure timely drug access and refills.
• Monitor patient cases to identify potential delays or issues and proactively resolve them (e.g., prior authorizations, benefit revalidations, prescription renewals).
• Educate patients and families about program resources, refill schedules, and financial assistance options.
• Elevate the patient experience by collaborating with market access, reimbursement, and specialty pharmacy teams to resolve coverage and dispensing challenges.
• Support patient onboarding, therapy continuation, and adherence initiatives in alignment with program KPIs.
• Verify insurance coverage, reimbursement processes, and general access for complex pharmaceuticals, explaining benefits offered by all payer types (private/commercial and government).
• Serve as a regional expert on reimbursement, co-pay, foundation assistance, and patient assistance program issues, handling patient and provider interactions with Regional Access Leads and Regional Account Managers.
• Communicate insurance benefit investigations, prior authorization, and appeal requirements, and triage cases according to SOPs.
• Serve as a direct point of contact to healthcare providers for ongoing support and relationship development by delivering detailed program information.
• Evaluate enrollment forms for data integrity and missing information.
• Follow program guidelines and escalate complex cases according to policy, SOPs, Call Guides, and other program materials.
• Document status in case management systems, communicate patient benefits, and assist in PA/Appeals processes.
• Act as an assigned liaison to customers, Market Access colleagues, internal stakeholders, and healthcare providers.
• Maintain open lines of communication with the Program Supervisor and share updates on patient status, prescriber feedback, and program effectiveness.
• Maintain confidentiality and privacy.
• Contribute to team morale with a positive attitude and maintain accurate, compliant documentation within CRM and case management systems.
• Undertake miscellaneous tasks or projects as assigned, including pharmacovigilance reporting where required (e.g., Adverse Events, Product Quality Complaints).

Qualifications

• Minimum 5+ years of experience in patient navigation, specialty pharmacy, case management, or patient access, preferably in biotech, rare disease, oncology, or cell/gene therapy.
• Strong understanding and experience in benefits verification, prior authorization, and reimbursement processes.
• Exceptional communication, organization, and problem-solving skills that have consistently improved patient experiences and outcomes.
• Proven ability to work independently in a high-volume, fast-paced, patient-focused environment.
• Empathetic and patient-centered mindset with a commitment to improving rare disease care.
• Ability to multitask and balance multiple priorities.
• Ability to deliver meaningful and concise conversations with integrity and empathy to patients and healthcare providers.
• Experience using CRM or case tracking systems (Salesforce Health Cloud preferred).
• In-depth understanding of health insurance benefits, state and federal laws, and insurance regulations.
• Excellent written and verbal communication and problem-solving skills to connect with patients, caregivers, and providers.
• Experience working in a complex matrix to accomplish goals with a patient-centric approach.
• Strong people skills, including flexibility, persistence, creativity, empathy, and trust.
• Robust computer literacy, including data entry and MS Office.
• Strong business acumen and strategic thinking skills.
• Ability to identify and handle sensitive issues, working independently and collaboratively within teams.

Education

• Preferred: BA/BS.

Additional Requirements

• Travel: Ability to travel up to ~10%, including weekends.