Case Manager

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

Benefits offered by this job

Medical, dental, and vision coverage

Life and disability insurance

401(k) with company match

Paid time off and holidays

Wellness days and recharge breaks

Family resources and leave

Job summary

Alnylam Pharmaceuticals, Inc. is seeking a healthcare reimbursement and case management professional to coordinate initiation and continuation of treatment with Alnylam products. You will liaise with patients, caregivers, providers, and payers to secure coverage and manage access to therapies.

The role requires strong communication, problem-solving, and cross-functional collaboration skills, with a focus on navigating private and public payer systems and providing patient support across regions.

Qualifications

• Bachelor’s degree in a health/medical field required.
• 3+ years case management experience in healthcare or biotech.
• Experience with insurance reimbursement, patient assistance programs, billing and coding.
• Knowledge of Medicare/Medicaid/private payer structures.
• Experience with Salesforce CRM.

Responsibilities

• Assess patients’ needs and develop action plans for initiation and continuation of treatment with Alnylam products, coordinating information with stakeholders.
• Understand and develop reimbursement, billing/coding, insurance plans, payer trends and patient assistance resources.
• Assist in obtaining insurance approval and plan for maintenance of coverage with patients, caregivers, and providers.
• Identify region-specific resources to support patient care.
• Develop action plans for complex patient-specific issues.
• Maintain expertise via CME and conferences on disease, reimbursement, and coverage.
• Educate patients and caregivers on insurance options, PA, and policy requirements.
• Foster relationships with internal/external customers (e.g., Medical, Sales, payer teams).
• Attend patient meetings and represent Alnylam at industry conferences.
• Ensure compliance with corporate policies with Legal/Regulatory teams.

Skills

Case management

Communication

Negotiation

Problem solving

Cross-functional collaboration

Education

Bachelor's Degree

Health Care/Social Work/Nursing (or related field) a plus

Tools

Salesforce.com

Job description

Summary of Key Responsibilities

• Assess patients’ needs and develop action plans that provide for the initiation and continuation of treatment with Alnylam products while coordinating the exchange of all applicable patient‑related information with appropriate internal and external stakeholders.
• Develop a comprehensive understanding of the reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, patient assistance programs, and related resources.
• Assist in obtaining insurance approval for Alnylam products, and proactively plan for maintenance of coverage by working with patients and their caregivers/families, healthcare providers, insurance companies, specialty pharmacies, and Alnylam colleagues.
• Understand the resources available in their specific region, and how they can be best employed to support patient care.
• Identify complex patient‑specific issues and develop and execute action plans accordingly.
• Maintain disease, reimbursement, and insurance coverage expertise through continuing medical education and attendance at relevant conferences and other educational opportunities.
• Educate patients, caregivers, family members, health‑care providers, and others regarding insurance options and limitations, including PA and policy requirements necessary to initiate and maintain treatment, patient services’ offerings and relevant disease/product information as necessary.
• Foster 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, 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 Alnylam 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 should include but not be limited to 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 process for infused and injectable products.
• Knowledge of private payer, Medicare, and Medicaid structure, systems, and reimbursement process required.
• 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, flexible, and energetic environment.
• Self‑starter who is highly passionate about rare disease and Alnylam’s core values:
  • Commitment to People, Innovation and Discovery, Sense of Urgency, Open Culture, and Passion for Excellence.
• Ability to travel 5%, including weekends/evenings, as needed.

U.S. Pay Range

$85,500.00 - $115,600.00

Benefits

Alnylam’s robust Total Rewards package is designed to support your overall health and well‑being. We offer comprehensive benefits including medical, dental, and vision coverage, life and disability insurance, a lifestyle reimbursement program, flexible spending and health savings accounts and a 401(k) with a generous company match. Eligible employees enjoy paid time off, wellness days, holidays, and two company‑wide recharge breaks. We also offer generous family resources and leave. Our commitment to your well‑being reflects our belief that caring for our people fuels the impact we create together.

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 their sex, gender or gender identity, sexual orientation, race, color, ethnicity, national origin, ancestry, citizenship, religion, creed, physical or mental 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.