Case Manager, West Coast

Alnylam Pharmaceuticals; United States; On-site; USD 86,000 - 116,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) with company match

Paid time off and wellness programs

Job summary

Alnylam Pharmaceuticals is seeking a Nurse Case Manager/Healthcare Coordinator to support patients and navigate insurance and reimbursement for Alnylam therapies.

Responsibilities include assessing patient needs, obtaining insurance approvals, coordinating with payers, caregivers, and providers, and ensuring access to treatment across regions, while staying compliant with policies and collaborating with cross-functional teams.

Qualifications

• Bachelor's Degree in a healthcare/social work or related field.
• 3+ years case management experience in healthcare/pharma or biotech.
• Experience with home care management, utilization review and patient assistance programs.
• Knowledge of private payer, Medicare, and Medicaid systems.
• Experience with Salesforce CRM.
• Strong written and verbal communication, negotiation and problem-solving.
• Ability to travel up to 5%, including weekends/evenings.

Responsibilities

• Assess patients’ needs and plan treatment initiation and continuation.
• Develop understanding of reimbursement processes and payer trends.
• Assist in obtaining insurance approval and maintain coverage.
• Identify regional resources to support patient care.
• Resolve complex patient-specific issues with action plans.
• Maintain knowledge through CME and conferences.
• Educate stakeholders on insurance options and policies.
• Foster cross-functional relationships across internal and external teams.
• Attend patient meetings and represent Alnylam at conferences.
• Ensure compliance with corporate and industry policies.

Skills

Communication skills

Problem solving

Negotiation

Independent work

Cross-functional collaboration

Education

Bachelor's degree

Tools

Salesforce.com

Job description

Overview

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.

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.

U.S. Pay Range

$85,500.00 - $115,600.00

The pay range 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).

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.

Learn more about these and additional benefits offered by Alnylam by visiting the Benefits section of the Careers website: https://www.alnylam.com/careers

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.