Location: Atlanta, GA, US
The Case Manager works in a highly visible, team and collaborative environment working with the reimbursement HUB, Patient Access Managers (PAMs) and Specialty Pharmacy.
The Case Manager will work with patients, providers, partners and insurance companies to address insurance challenges, which may include prior authorizations, reauthorizations, insurance changes, and appeals.
The Case Manager will manage a caseload and will work within the pre-determined process to gain access to the prescribed therapy, troubleshooting issues with insurance authorization and distribution of KRYSTEXXA. The Case Manager is accountable for providing exceptional customer service, at all touch points. The ability to anticipate challenges and address them understanding the time sensitivity of each case. The Case Manager must listen to and support patients and medical professionals, addressing their specific needs, providing friendly, courteous, professional and well-informed answers and solutions to their questions and needs.
The Case Manager will develop and maintain relationships with patients and providers supporting therapy adherence. The Case Manager must be able to support regional geographies and time zones.
Day to day oversight and awareness of patient customer service issues with insurance, the specialty pharmacy, and patient support programs
Work closely with the Reimbursement Team, PAMs, the hub, pharmacy, and the patient/family to case manage all steps required to gain access to therapy
Partner with Safety and Pharmacovigilance and report adverse events 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
Daily interaction with sales representatives, patient services support and medical affairs to ensure current and accurate communication on the status of insurance approvals and reauthorizations
Assist in developing strategy, 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 meetings
Qualifications And Skills Required
Bachelor’s Degree required.
5+ years of experience in the pharmaceutical industry.
2+ years prior experience as a case manager.
Buy and bill experience required.
Scientific or nursing background a plus.
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.
Up to 20% travel required.
Proficient in Microsoft Office.
Strong interpersonal skills.
Excellent written and verbal communication skills.
Horizon Core Values & Competencies
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