Case Manager, West Coast

Alnylam Pharmaceuticals, Inc.; Northern (KY); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Life insurance

Disability insurance

Flexible spending account

Health savings account

401(k) with company match

Paid time off

Wellness days

Holidays

Job summary

Alnylam Pharmaceuticals, Inc. seeks a proactive Case Manager to coordinate patient access and reimbursement for RNAi therapies. You will work with patients, caregivers, providers, and payers to obtain approvals and maintain coverage, leveraging your experience in home care and insurance processes.

The role requires 3+ years of case management in healthcare or biotech, strong communication, and ability to travel up to 5%. A Bachelor's degree is required, with familiarity of Salesforce.com a plus.

Qualifications

• Bachelor's Degree required; Health Care/Social Work/Nursing or related field a plus.
• 3+ years recent case management experience in healthcare, biotech or pharma.
• Experience in home care management, case management review, utilization review, social services, insurance reimbursement or billing/coding.
• Knowledge of benefit verification and prior authorization for infused/injectable products.
• Familiarity with private payer, Medicare, Medicaid structures and reimbursement processes.
• Experience with a CRM such as Salesforce.com.

Responsibilities

• Assess patients’ needs and develop action plans for initiating and continuing treatment with Alnylam products.
• Develop understanding of reimbursement, billing/coding nuances, insurance plans and patient assistance programs.
• Assist in obtaining insurance approval and plan for maintenance of coverage with patients, caregivers, providers and others.
• Identify region-specific resources to support patient care and coordinate with internal/external stakeholders.
• Identify complex patient-specific issues and develop action plans accordingly.
• Maintain disease, reimbursement and insurance coverage expertise through CME and conferences.

Skills

Case management

Healthcare experience

Communication

Education

Bachelor's Degree

Tools

Salesforce.com

Job description

Alnylam (Nasdaq: ALNY) is delivering on a bold vision to turn scientific possibility into reality, with a robust RNA interference (RNAi) therapeutics platform. As the pioneer in RNAi and the leading RNAi therapeutics company, we have always been uncompromisingly dedicated to translating the breakthrough science into transformational medicines to help as many people as possible. Long focused on rare and genetic diseases, our scientific advances are now allowing us to bring the power of RNAi therapeutics to more prevalent diseases and as a result, we are beginning to recognize the full potential of this new class of medicines.

Alnylam is committed to its journey to become a top 5 independent, global biopharma company. We are already admired and recognized for our dedication to patients, company culture that empowers people to do their best work, track record of scientific innovation, social responsibility, and commercial excellence.

Founded in 2002, and headquartered in Cambridge, Mass., Alnylam has over 1,650 employees at work across the globe. We are seeking smart, passionate, "change the world" kind of people who are ready to say, "challenge accepted" to our mission. Thanks to the commitment of every employee globally, Alnylam is proud to have been recognized as one of Fast Company’s 2021 Best Workplaces for Innovators, a Science Magazine Top Employer three years in a row (2019-2021), a Boston Globe Top Places to Work seven years in a row (2015-2021), a Great Place to Work in Asia, Japan, Brazil, the U.K., Germany, Spain, Netherlands, Italy, France and Switzerland, Seramount’s 100 Best Companies (formerly Working Mother 100 Best Companies) and Best Companies for Dads, Bloomberg’s Gender Equality Index two years in a row (2021-2022), among others. At Alnylam, we are committed to fostering a diverse, equitable and inclusive work environment, culture, and workforce, and we support several Employee Resource Networks.

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

We are the leader in RNAi therapeutics- a revolutionaryapproach with the potential to transform the lives of people with rare and common diseases. Built on Nobel Prize-winning science, Alnylam has delivered the breakthroughs that made RNAi therapeutics possibleand are just at the beginning of what’s possible. Our deep pipeline, late-stage programs, and bold vision reflect our core values: fierce innovation, passion for excellence, purposeful urgency, open culture and commitment to people. We're proud to be a globally recognized top employer, wherean authentic, inclusive culture and breakthrough thinkingfuel one another.

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.

The pay range below reflects the full-time base salary range we expect to pay for this role at the time of posting. Base pay will be determined based on a number of factors including, but not limited to, relevant experience, skills, and education. This role is eligible for an annual short-term incentive award (e.g., bonus or sales incentive) and an annual long-term incentive award (e.g., equity).

• medical coverage
• dental coverage
• vision coverage
• life insurance
• disability insurance
• lifestyle reimbursement program
• flexible spending account
• health savings account
• 401(k) with a generous company match
• paid time off
• wellness days
• holidays
• two company-wide recharge breaks
• generous family resources and leave