Pharmaceutical Case Manager II (contract)

Sanofi; Cambridge (MA); Remote; USD 66.000 - 94.000; Teilzeit

Zusammenfassung

Sanofi is seeking a Case Manager II for a 6-month contract to lead end-to-end case management ensuring eligible patients gain timely access to life-changing oncology therapies.

Role requires expertise in navigating insurance landscapes, resolving reimbursement barriers, and partnering with healthcare providers and payer organizations. Remote (US-based) position with 11 AM–7 PM ET schedule.

Qualifikationen

• Understanding of health insurance benefits and reimbursement processes.
• Familiarity with billing and coding guidelines and pharmacy benefits.
• Excellent communication and problem-solving skills; able to handle sensitive issues diplomatically.
• Ability to work independently and collaboratively in cross-functional teams.
• Strong business acumen and patient support services experience in healthcare.
• CRM data entry and reporting proficiency.

Aufgaben

• Lead the case management process to assess patient needs and plan actions to support treatment initiation and continuation.
• Conduct benefits investigations to evaluate coverage and structure of plans for oncology therapies.
• Coordinate access to Free Goods and Copay assistance programs for eligible patients.
• Educate patients, caregivers and providers on insurance options, billing guidelines and patient support programs.
• Maintain up-to-date knowledge of payer landscapes and utilization criteria for products.
• Coordinate exchange of patient information with internal and external stakeholders professionally.

Kenntnisse

Health benefits knowledge

Billing & coding guidelines

Strong communication

Independent & collaborative

CRM proficiency

Problem-solving

Business acumen

Patient advocacy

Ausbildung

Bachelor's degree required

Healthcare/ social work/ nursing preferred

Jobbeschreibung

Job Title: Case Manager II

Location: Remote (US based only)

Type: Contract (W2)

Term: 6-months

Schedule: Monday - Friday; 11 AM - 7 PM ET

Pay Rate Max: $58 per hour

Sanofi's contingent workforce program, FLEXT Direct, is seeking a Case Manager II for a 6-month contract.

This associate will join our dynamic Patient Support Services team within the US Oncology business unit. In this senior-level case management role, you will serve as a subject matter expert and patient advocate, leading the end-to-end case management process to ensure eligible patients gain timely access to life-changing oncology therapies. You will balance the complex needs of patients and caregivers with organizational objectives, navigating intricate insurance landscapes, resolving reimbursement barriers, and fostering meaningful relationships with healthcare providers, internal stakeholders, and payer organizations. This role demands a high level of business acumen, entrepreneurial drive, and a deep commitment to improving patient outcomes.

Responsibilities

• Lead the case management process by assessing patient needs and developing strategic action plans that support treatment initiation and continuation while eliminating or mitigating barriers
• Conduct comprehensive benefits investigations to evaluate coverage and benefit structures of individual patient insurance plans as they relate to oncology therapies
• Facilitate insurance approvals and coordinate access to Free Goods and Copay assistance programs for eligible patients
• Educate patients, caregivers, healthcare providers, and office personnel on insurance options, billing and coding guidelines, medical and pharmacy benefits, and patient support program offerings
• Establish and maintain up-to-date knowledge of local and national payer landscapes, including Specialty Pharmacy and Utilization Management criteria for assigned products
• Compliantly coordinate the exchange of patient-related information with internal and external stakeholders, maintaining professional and effective relationships throughout
• Collaborate cross-functionally with internal partners including Patient Support Specialists, Medical, Sales, and Market Access teams to resolve payer coverage issues
• Attend patient meetings, site visits, and professional congresses to represent the organization and educate individuals on case management services and support program offerings
• Demonstrate accountability for action plan execution and proactively identify complex patient-specific issues requiring escalated resolution strategies
• Maintain accurate and comprehensive documentation within the CRM platform, including insurance data, coverage approvals, and all patient and provider interactions
• Leverage CRM reporting tools and data analytics to make strategic territory decisions while prioritizing patient and customer needs
• Share reimbursement knowledge and best practices with team members through orientation training, case studies, and consultation on complex cases
• Monitor systems, processes, and potential gaps, offering innovative ideas and solutions to continuously elevate the support program
• Provide caseload coverage outside of assigned territory as needed

Skills

• In-depth understanding of health insurance benefits, reimbursement processes, and payer claims procedures
• Strong knowledge of billing and coding guidelines, medical and pharmacy benefit structures, and insurance plan trends
• Excellent communication, mediation, and problem-solving skills with the ability to handle sensitive issues diplomatically
• Ability to work independently and collaboratively within cross-functional teams
• High level of business acumen and understanding of patient support services within a commercial healthcare environment
• Proficiency in CRM tools and data entry with strong computer literacy
• Demonstrated ability to identify complex issues and develop and execute effective action plans
• Entrepreneurial mindset with a drive for continuous improvement and results
• Experience supporting senior patient populations is a plus

Experience

• Bachelor's degree required; degree in healthcare, social work, or nursing preferred
• 3–5 years of patient- or caregiver-facing experience required, including areas such as home care management, case management, utilization review, social service support, insurance reimbursement, or patient advocacy
• Direct experience in the case management field preferred
• Industry experience within pharmaceutical or biotech patient support services preferred
• Familiarity with relevant state and federal laws and insurance regulations required
• Ability to travel up to 10–15% (1-2 trips max)