Lead Patient Navigator Social Worker

CareMetx, LLC; United States; Remote; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a Lead Patient Navigator Social Worker to guide a high-performing team in enhancing patient access to therapies. This pivotal role involves managing strategies for therapy access, educating patients and caregivers, and ensuring compliance with reimbursement processes. The ideal candidate will possess extensive experience in the pharmaceutical or healthcare sector, strong leadership abilities, and a commitment to improving patient outcomes. Join a dynamic team dedicated to making a difference in patients' lives while enjoying a flexible schedule and the opportunity for significant travel.

Qualifications

• 10+ years experience in pharmaceutical or healthcare industry.
• 3+ years in reimbursement management and people management.

Responsibilities

• Lead patient access strategies and manage a team of Case Managers.
• Collaborate with program leaders to support therapy launches.

Skills

Listening Skills

Analytical Skills

Leadership

Communication Skills

Customer Care Knowledge

Adaptability

Education

Bachelor’s Degree

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Join to apply for the Lead Patient Navigator Social Worker role at CareMetx, LLC

Description

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

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. This role also works closely with patients, caregivers, and providers to support patient access to therapy and ensure ongoing compliance.

Primary Duties and Responsibilities:

• Lead execution of patient access strategies for all therapies.
• Collaborate with program leaders to develop strategies supporting new therapy launches and existing therapy access.
• Ensure regional patient access performance meets company objectives through team management.
• Educate teams on patient access issues.
• Implement and monitor team objectives, coaching, and development.
• Work closely with patients, caregivers, providers, and pharmacy partners to facilitate access and reimbursement.
• Manage case histories, resolve reimbursement issues, and support patient assistance requests.
• Coordinate with sales and market access teams.
• Answer inquiries and provide ongoing support to patients and providers.
• Provide backup coverage as needed and maintain reliable attendance.

Experience and Educational Requirements:

• Minimum 10+ years in pharmaceutical/healthcare industry.
• Minimum 3+ years in reimbursement management.
• Minimum 3+ years in people management.
• Bachelor’s Degree preferred.
• Licensed social worker or equivalent experience.
• Must live within 45 minutes of a major airport and be able to travel extensively (overnight) 50% of the time.
• Schedule flexibility to support coverage hours from 9 am-9 pm EST.

Skills and Abilities:

• Excellent listening, written, and analytical skills.
• Proficiency in Word, Excel, PowerPoint.
• Knowledge of customer care processes.
• Strong leadership and communication skills.
• Ability to adapt to change.
• Compliance with applicable laws and policies.
• Proven track record of meeting goals.
• Dedicated home office space required.
• Ability to attend in-person training for 3 days.

Physical Demands and Work Environment:

Regular sitting, occasional lifting up to 10 pounds. Moderate noise level. Work from home with travel as specified.

Schedule:

• Flexible hours including alternating coverage from 9 am-9 pm EST.
• Must live near a major airport and be able to travel extensively.
• Attendance at 3-day onboarding training required.

CareMetx considers equivalent experience and education. We are an equal opportunity employer.