Case Manager

Alnylam Pharmaceuticals; United States; On-site; USD 85,500 - 115,600; Full time

Benefits offered by this job

Medical, dental, vision insurance

401(k) with company match

Paid time off and holidays

Wellness programs

Job summary

Alnylam Pharmaceuticals is seeking a patient access and reimbursement specialist to assess patients’ needs, develop action plans for initiation and continuation of treatment, and coordinate exchange of patient information with internal and external stakeholders.

You will oversee reimbursement processes, billing and coding, prior authorization, and payer trends; travel up to 5% and work with cross‑functional teams to ensure coverage and access for rare disease therapies.

Qualifications

• Bachelor’s degree required; health care-related field a plus.
• 3+ years recent case management experience in healthcare/pharma/biotech.
• Experience including home care management, case management review, utilization review, social service support, insurance reimbursement, patient assistance programs, or billing and coding.
• Knowledge of benefit verification and prior authorization for infused and injectable products.
• Knowledge of private payer, Medicare, and Medicaid structures and reimbursement processes.
• Proficiency in a CRM system such as Salesforce.com.
• Strong written and verbal communication, listening, critical thinking, problem solving, negotiation and mediation skills.
• Ability to navigate difficult conversations and manage competing priorities.

Responsibilities

• Assess patients’ needs and develop action plans for initiation and continuation of treatment, coordinating exchange of patient‑related information with stakeholders.
• Develop a comprehensive understanding of reimbursement processes, billing/coding, insurance plans, payer trends, financial and patient assistance programs.
• Assist in obtaining insurance approval for Alnylam products and proactively plan for maintenance of coverage.
• Identify complex patient‑specific issues and develop and execute action plans.
• Maintain disease, reimbursement, and insurance coverage expertise through continuing education.
• Educate patients, caregivers, health-care providers, and others regarding insurance options, policy requirements, patient services, and relevant product information.
• Foster collaborative relationships with internal and external customers, including Patient Education Liaisons, medical, sales, field reimbursement, corporate accounts, patient advocacy, insurance case managers, specialty pharmacies, home health agencies, and office coordinators.
• Attend patient meetings and represent Alnylam at industry conferences as needed.
• Ensure compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance.

Skills

Case management

Insurance reimbursement

Medicare/Medicaid knowledge

Salesforce.com

Communication skills

Independent work

Cross-functional collaboration

Negotiation/mediation

Travel readiness

Education

Bachelor’s Degree

Tools

Salesforce.com

Job description

Overview

Alnylam (Nasdaq: ALNY) is a leading RNA interference (RNAi) therapeutics company dedicated to translating breakthrough science into medicines for rare and genetic diseases, with a robust RNAi therapeutics platform and a focus on patient access and reimbursement.

Key Responsibilities

• Assess patients’ needs and develop action plans for initiation and continuation of treatment, coordinating exchange of patient‑related information with stakeholders.
• Develop a comprehensive understanding of reimbursement processes, billing/coding, insurance plans, payer trends, financial and patient assistance programs.
• Assist in obtaining insurance approval for Alnylam products and proactively plan for maintenance of coverage.
• Identify complex patient‑specific issues and develop and execute action plans.
• Maintain disease, reimbursement, and insurance coverage expertise through continuing education.
• Educate patients, caregivers, health‑care providers, and others regarding insurance options, policy requirements, patient services, and relevant product information.
• Foster collaborative relationships with internal and external customers, including Patient Education Liaisons, medical, sales, field reimbursement, corporate accounts, patient advocacy, insurance case managers, specialty pharmacies, home health agencies, and office coordinators.
• Attend patient meetings and represent Alnylam at industry conferences as needed.
• Ensure compliance with all corporate and industry policies in collaboration with Legal, Regulatory and Compliance.

Qualifications

• Bachelor’s Degree required; Health Care, Social Work, Nursing or related field a plus.
• 3+ years recent case management experience in the healthcare or pharmaceutical/biotech industry; ultra‑rare disease experience a plus.
• Experience including home care management, case management review, utilization review, social service support, insurance reimbursement, patient assistance programs, or billing and coding.
• Knowledge of benefit verification and prior authorization for infused and injectable products.
• Knowledge of private payer, Medicare, and Medicaid structures and reimbursement processes.
• Proficiency in a Customer Relationship Management System such as Salesforce.com.
• Strong written and verbal communication, listening, critical thinking, problem solving, negotiation and mediation skills.
• Ability to navigate difficult conversations and handle sensitive issues.
• Ability to work independently and manage competing priorities.
• Experience working in cross‑functional teams and influencing without authority.
• Desire to innovate in a fast‑paced, flexible environment.
• Self‑starter highly passionate about rare disease and Alnylam’s core values.
• Commitment to People, Innovation and Discovery, Sense of Urgency, Open Culture, Passion for Excellence.
• Ability to travel 5%, including weekends/evenings, as needed.

U.S. Pay Range

85,500.00 – 115,600.00 per year. Base pay determined by experience, skills, and education. Eligible for short‑term incentive award (e.g., bonus) and long‑term incentive award (e.g., equity). Comprehensive benefits including medical, dental, vision, life, disability, lifestyle reimbursement, flexible spending and health savings accounts, 401(k) with company match, paid time off, wellness days, holidays, company recharge breaks, family resources and leave.

Equal Employment Opportunity

At Alnylam, we commit to an inclusive recruitment process and equal employment opportunity. Qualified applicants will receive consideration for employment without regard to sex, gender or gender identity, sexual orientation, race, color, ethnicity, national origin, ancestry, citizenship, religion, creed, disability, pregnancy status or related conditions, genetic information, veteran or military status, marital or familial status, political affiliation, age, or any other factor protected by federal, state, or local law. Alnylam is an E‑Verify Employer.