Case Manager

Location: Cambridge, MA

Job Description:

Alynam.PNG

The CM will be responsible for interfacing with patients affected by hATTR amyloidosis, their caregivers, and healthcare providers (HCPs), to facilitate unencumbered access to Patisiran. The CM will work collaboratively with internal and external stakeholders to meet individual patients’ needs through personalized, compassionate communication and high-touch services. . He/she is responsible for engaging multiple stakeholders in support of getting appropriate hATTR individuals started on therapy and staying on therapy. The CM focuses on identifying and coordinating various services that individual patients may need to get access to therapy and recognizing and removing reimbursement barriers that prevent the individual from remaining on therapy.

The successful candidate must be passionate about science and deeply motivated by the quest of delivering value to patients and their families with the long-term success of the company in mind. He/she will be responsible for providing a smooth customer interaction from initial intake through supporting continued patient access to therapy. He/she will manage the logistical issues impacting treatment initiation and ongoing therapy. The CM demonstrates understanding of the department business objectives and measures and demonstrates strengths working independently as well as collaboratively within a highly matrixed environment.

Additional Information: Flexibility

  • This position allows for the flexibility to work from home up to 3 days per week which will happen after 6 months on the job

  • Once the team is fully staffed we will need to balance business needs with personal flexibility needs; our goal will be to accommodate personal flexibility needs, however, there will be times when attendance in the office is required for certain meetings and we will be forthcoming with those details as we go

Summary Of Key Responsibilities

Assesses patients’ needs and develops action plans that provide for the initiation and continuation of treatment with Patisiran while coordinating the exchange of all applicable patient-related information with appropriate internal and external customers

  • Develops a comprehensive understanding of the reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, patient assistance programs, 501(c)3 foundations, and related resources

  • Assists in obtaining insurance approval for Patisiran, and proactively plans for maintenance of coverage by working with patients and their caregivers/families, healthcare providers, insurance companies, specialty pharmacies, and Alnylam colleagues

  • Understands the resources available in their specific region, and how they can be best employed to support patient care

  • Identifies complex patient specific issues, and develops and executes action plans accordingly

  • Maintains disease, reimbursement and insurance coverage expertise through continuing medical education and attendance at relevant conferences and other educational opportunities

  • Educates patients, caregivers, family members, health care providers, and others regarding insurance options and limitations, including requirements necessary to initiate and maintain treatment, patient services’ offerings and relevant disease/product information as necessary

  • Fosters collaborative relationships with all internal and external customers including but not limited to patient education liaisons, medical, sales, field reimbursement, corporate accounts, patient advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators

  • Maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions

  • Attend patient meetings and represent Alnylam at industry conferences

  • Ensures compliance with all corporate and industry policies in collaboration with Alnylam Legal, Regulatory and Compliance

Qualifications

  • Bachelor’s Degree in Health Care/Social Work/Nursing (or equivalent)

  • 3+ years recent case management experience in the healthcare or pharmaceutical/biotech industry. Ultra-rare disease experience a plus.

  • Experience should include but not be limited to home care management, case management review, utilization review, social service support, insurance reimbursement, billing and coding, and patient advocacy

  • Knowledge of private payer, Medicare, and Medicaid structure, systems, and reimbursement process

  • Experience and proficiency in working with a Customer Relationship Management System, such as Salesforce.com

  • Possess strong written and verbal communication skills, exceptional listening, critical thinking, problem solving, negotiation and mediation skills

  • Ability to navigate difficult conversations and handle sensitive issues with opposing opinions

  • Ability to work independently and manage competing priorities

  • Experience working in cross-functional teams and effective in influencing without authority

  • Desire to innovate and work in a fast-paced, energetic environment

  • Self-starter who is highly passionate about rare disease and Alnylam’s core values:

  • Commitment to People, Innovation, Discovery, Sense of Urgency, Open Culture, and Passion for Excellence.

  • Ability to travel up to 25%, including weekends

Expectations

  • Clear Alignment with Alnylam Core Values:

  • Commitment to People

  • Innovation and Discovery

  • Sense of Urgency

  • Open Culture

  • Passion for Excellence

 

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