Lead Patient Navigator Social Worker

CareMetx, LLC; United States; Teletrabalho; USD 110 000 - 160 000; Tempo integral

Resumo da oferta

CareMetx is hiring a Lead Patient Navigator Social Worker to manage and coach a field-based team that educates patients and families on product access and reimbursement. You will drive strategies to improve therapy access and ensure compliance, working with providers and payers to resolve coverage questions.

Applicants should have 10+ years in pharma/healthcare, a MSW, and at least 3 years of people management, with flexible hours for coverage and remote work options.

Qualificações

• 10+ years of experience in pharma/healthcare.
• 3+ years reimbursement management experience.
• 3+ years direct people management experience.
• Master of Social Work (MSW) required.
• Schedule flexibility to provide backup coverage outside standard hours (9 am–5 pm).

Responsabilidades

• Lead a field-based team of Case Managers delivering patient access and reimbursement support.
• Educate teams on patient access issues and reimbursement processes.
• Coordinate with pharmacists, hub, and providers for therapy access.
• Manage case histories in CRM and monitor performance against objectives.
• Provide backup coverage during absences and coordinate travel as needed.

Conhecimentos

Leadership

Communication

Interpersonal skills

Analytical skills

Formação académica

MSW

Ferramentas

Word

Excel

PowerPoint

Descrição da oferta de emprego

From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.

Job Title: Lead Patient Navigator Social Worker

POSITION SUMMARY:

Under the general direction of Operations Management, the Lead Case Manager is responsible for managing, coaching, developing, directing, and leading a high performing team of field-based Case Managers who educate patients and their families on product access, reimbursement processes, and help with the management of therapy delivery. In addition, this role will work closely with patients, caregivers, and providers to help support a patient gain access to therapy and help ensure ongoing compliance with therapy.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Responsible for leading the execution of patient access-related strategies and objectives for all assigned therapies
• Collaborate with other program leaders as appropriate to develop new strategies that support both the launch of new therapies and/or advance patient access for existing therapies
• Work with and through Case Managers to ensure regional patient access performance meets or exceeds Regeneron company objectives.
• Educate field-based teams, as appropriate, on patient access issues.
• Implement Management by Objectives (MBOs) for each Case Manager to ensure team objectives are achieved.
• Effectively coach, develop, motivate and monitor team performance to include regular and timely feedback, actionable development plans that nurture talent for increased responsibility, early identification of performance challenges or deficiencies and creation of action plans to address performance gaps.
• Works closely with patients/caregivers and providers to gain access to therapy
• Work with Specialty Pharmacy and Hub to obtain reimbursement coverage
• Provide information to patient/caregiver on reimbursement options and financial assistance options
• Manage transition to home therapy as appropriate. Work closely with specialty infusion pharmacies and nursing agencies to help coordinate reimbursement and supplies
• Responsible for maintaining case history for all assigned patients in the CRM system
• Help to resolve ongoing reimbursement issues (insurance changes, PA’s, other)
• Work with Field Sales Reps and Market Access team
• Answer patient and medical office inquiries, as appropriate, and help resolve customer problems related to access and reimbursement
• Provide ongoing support by making regular calls and potentially scheduling in-person meetings with patients/families
• Manage patient assistance requests and work with partners to process applications
• Provide backup coverage for program operations and covering Case Manager responsibilities in the event of planned/unplanned absences and support needs in excess of capacity in a given territory

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• Minimum 10+ years' experience in the pharmaceutical/healthcare industry
• Minimum of 3+ years reimbursement management experience.
• Minimum of 3+ years direct people management experience.
• Master of Social Work required.
• Schedule flexibility to be able to provide backup coverage for program operations and covering Case Manager responsibilities in the event of planned/unplanned absences and support needs in excess of capacity in a given territory between the operating hours of 9 am-5 pm

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Exceptional listening, written and analytical skills.
• Proficient in Word, Excel, and PowerPoint for presentation and report development.
• Strong knowledge of customer care processes and techniques.
• Excellent leadership, communication, and interpersonal skills.
• Flexible, detailed, and able to successfully adapt to change.
• Complies with all laws, regulations, and policies that govern CareMetx activities related to the contact center.
• Proven track record of meeting or exceeding goals and objectives.
• Work from home position, requires a dedicated office space that is quiet and free from distractions
• Must be able to attend in person onboarding training for 3 days (i.e. product training etc.)

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule

• Schedule flexibility including alternating coverage between 9 am -9 pm EST
• Must be able to travel, one to two times a month for field visits or field visits supervisions.

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin