Case Manager, West Coast

Alnylam Pharmaceuticals

22h•$85,500 - $115,600•Remote

About The Position

Alnylam is seeking a Case Manager for the West Coast to assess patients’ needs and develop action plans for treatment initiation and continuation with Alnylam products. This role involves coordinating patient-related information with internal and external stakeholders, developing a comprehensive understanding of the reimbursement process, and assisting in obtaining insurance approval. The Case Manager will proactively plan for coverage maintenance, understand regional resources to support patient care, and identify and resolve complex patient-specific issues. They will also maintain expertise in disease, reimbursement, and insurance coverage through continuing education and represent Alnylam at industry conferences. Ensuring compliance with all corporate and industry policies is also a key responsibility.

Requirements

Bachelor’s Degree required.
3+ years recent case management experience in the healthcare or pharmaceutical/biotech industry.
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.

Nice To Haves

Health Care/Social Work/Nursing (or related field) a plus.
Ultra-rare disease experience a plus.

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.