Case Manager, Rare Disease Patient Services

Responsibilities

• Manage a caseload efficiently while consistently meeting established key performance indicators (KPIs).
• Review new and restart patient enrollments for completeness and oversee the entire enrollment process from receipt through product shipment, including benefits investigations, prior authorization, specialty pharmacy, nurse training coordination, and shipment scheduling.
• Serve as the primary point of contact for patients, providing consistent support from enrollment through treatment initiation and throughout their treatment journey.
• Build and maintain strong relationships with patients, caregivers, and healthcare providers by delivering timely, personalized communication based on individual needs and preferences.
• Educate patients and caregivers on insurance benefits, financial assistance programs, patient support services, and available resources.
• Coordinate treatment access, initiation, and ongoing therapy by collaborating with healthcare providers, payers, specialty pharmacies, and internal cross‑functional teams.
• Monitor each patient's treatment progress, proactively identify barriers to therapy, and implement timely solutions to prevent delays or interruptions in care.
• Establish and maintain compliant relationships with internal stakeholders, including Sales and Market Access teams, as well as external partners such as specialty pharmacies and HCP staff to ensure a seamless patient experience.
• Identify and communicate trends related to reimbursement challenges, access delays, patient concerns, and operational issues, providing recommendations for process improvements.
• Maintain accurate and timely documentation while ensuring compliance with program guidelines, HIPAA regulations, and all applicable privacy and regulatory requirements.
• Participate in team meetings, contribute to continuous process improvement initiatives, and collaborate on solutions to enhance operational efficiency and patient outcomes.

Requirements

• Bachelor’s degree or equivalent experience required.
• 5+ years of experience in the pharmaceutical or biotechnology industry.
• 2–5 years of experience in case management, patient access, patient support, healthcare, specialty pharmacy, reimbursement, or a related healthcare setting.
• Experience managing a high‑volume caseload while meeting productivity goals and service‑level expectations.
• Ability to prioritize multiple cases, manage competing deadlines, and work independently in a fast‑paced environment.
• Knowledge of insurance verification, benefits investigations, prior authorizations, appeals, and reimbursement processes.
• Previous experience with specialty and medical benefits processes and billing.
• Rare disease experience a plus.
• Experience collaborating with patients, healthcare providers, specialty pharmacies, payers, and multidisciplinary teams.
• Excellent communication, customer service, organizational, and problem‑solving skills.
• Experience working with specialty medications, rare disease, oncology, immunology, neurology, or other specialty therapeutic areas is preferred.
• Core Competencies

Demonstrates expertise in managing patient enrollment processes, coordinating treatment access, and ensuring compliance with regulatory requirements.

Proficient in building relationships with patients and healthcare providers while effectively navigating insurance and reimbursement challenges.

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