Case Manager, East Coast (Remote)

Alnylam Pharmaceuticals; United States; Remote; USD 50,000 - 65,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager for the East Coast, focusing on remote patient support. This role involves assessing patient needs, navigating complex insurance processes, and fostering collaborative relationships with healthcare providers. You will play a crucial role in ensuring patients receive necessary treatments while maintaining compliance with industry standards. Join a forward-thinking company that values innovation and excellence in patient care, and be part of a team that is committed to transforming lives through groundbreaking therapies. If you are passionate about making a difference in the healthcare field, this opportunity is for you.

Qualifications

• 3+ years case management experience in healthcare or pharma.
• Knowledge of benefit verification and prior authorization process.

Responsibilities

• Assess patients’ needs and develop action plans for treatment.
• Educate patients and caregivers on insurance options and limitations.

Skills

Case Management

Reimbursement Process

Insurance Approval

Patient Education

Communication Skills

Problem Solving

Critical Thinking

Education

Bachelor’s Degree in Health Care/Social Work/Nursing

Tools

Salesforce.com

Job description

Join to apply for the Case Manager, East Coast (Remote) role at Alnylam Pharmaceuticals

Join to apply for the Case Manager, East Coast (Remote) role at Alnylam Pharmaceuticals

Get AI-powered advice on this job and more exclusive features.

• 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.
• Develops a comprehensive understanding of the reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, patient assistance programs, and related resources.
• Assists in obtaining insurance approval for Alnylam products, 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 PA and policy 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, and office coordinators.
• Attend patient meetings and represent Alnylam at industry conferences, as needed
• Ensures compliance with all corporate and industry policies in collaboration with Alnylam Legal, Regulatory and Compliance.
  
  

This role is considered Virtual.

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.
• Develops a comprehensive understanding of the reimbursement process, billing/coding nuances, insurance plans, payer trends, financial assistance programs, patient assistance programs, and related resources.
• Assists in obtaining insurance approval for Alnylam products, 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 PA and policy 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, and office coordinators.
• Attend patient meetings and represent Alnylam at industry conferences, as needed
• Ensures 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.
  

About Alnylam: Alnylam Pharmaceuticals (Nasdaq: ALNY) has led the translation of RNA interference (RNAi) into a whole new class of innovative medicines with the potential to transform the lives of people afflicted with rare and more prevalent diseases. Based on Nobel Prize-winning science, RNAi therapeutics represent a powerful, clinically validated approach to treating diseases at their genetic source by “interfering” with mRNA that cause or contribute to disease. Since our founding in 2002, Alnylam has led the RNAi Revolution and continues to turn scientific possibility into reality.

Our culture: Our people-first culture is guided by our core values: fiercely innovative, open culture, purposeful urgency, passion for excellence, and commitment to people, and these values influence how we work and the business decisions we make. Thanks to feedback from our employees over the years, we’ve been fortunate to be named a top employer around the world. Alnylam is extremely proud to have been recognized as the #1 Large Employer by Boston Globe Top Places to Work in 2023 for the third consecutive year, one of Science Magazine’s Top Biopharma Employers, one of America's Most Responsible Companies for 2024 by Newsweek, a Fast Company Best Workplace for Innovators, and a Great Place to Work in Canada, France, Italy, Spain, Switzerland, and UK – among others.

At Alnylam, we commit to an inclusive recruitment process and equal employment opportunity. We are dedicated to building an environment where employees can feel that they belong, can bring their authentic selves to work, and achieve to their full potential. By empowering employees to embrace their unique differences at work, our business grows stronger with advanced and original thinking, allowing us to bring groundbreaking medicines to patients. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity or expression, national origin, ethnicity, marital status, protected veteran status, disability, or any other characteristics prohibited by law.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

Referrals increase your chances of interviewing at Alnylam Pharmaceuticals by 2x

Get notified about new Case Manager jobs in United States.

California, United States $22.00-$26.00 1 week ago

Sexual Assault Case Manager - Remote, anywhere in the US

United States $50,000.00-$65,000.00 3 weeks ago

Cleveland, OH $65,000.00-$85,000.00 1 month ago

United States $65,000.00-$75,000.00 3 months ago

California, United States $25.00-$40.00 2 weeks ago

Short Term Disability Case Manager - Remote

North Carolina, United States 1 month ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.