Director of Case Management, Rezurock MyRock Assist

Sanofi•Morristown, NJ

21h•Remote

About The Position

Join the team transforming care for people with immune challenges, rare diseases, cancers, and neurological conditions. In Specialty Care, you’ll help deliver breakthrough treatments that bring hope to patients with some of the highest unmet needs. Position Summary : The Director of Case Management, Rezurock MyRock Assist is a strategic leadership role within Sanofi Patient Support Services (PSS), aligned to the PSS Case Management job family, responsible for leading all case management operations supporting the Rezurock patient population through the MyRock Assist hub program. This role owns the end-to-end patient journey from enrollment through sustained therapy access, overseeing hub-level case management operations, direct patient counseling on insurance coverage and program eligibility, financial assistance coordination, and the full spectrum of access barrier resolution. The Director leads, develops, and continuously optimizes the hub case management team and workflows, ensuring patients receive timely, accurate, and compassionate support in understanding their insurance coverage for Rezurock therapy. A defining feature of this role extending beyond case management oversight is the AFP (Alternate Funding Provider) strategy leadership responsibility. The Director serves as the General Medecines PSS organization's primary subject matter expert on AFP identification, assessment, and mitigation, owning the end-to-end strategy for preserving patient access to commercially covered therapies being subverted by AFP schemes targeting manufacturer Patient Assistance Programs. The Director leads the development and refinement of AFP detection methodologies, maintains cross-Sanofi AFP intelligence coordination, and integrates therapeutic area-specific patient and provider needs with enterprise AFP solutions. In addition to AFP mitigation, this role owns the maximizer and accumulator mitigation strategies in support of the copay program for Rezurock , building on a maximizer strategy that has delivered over $10 million in savings to date. The Director oversees performance monitoring of accumulator program impact on patient access and copay card utilization, evaluates the viability of emerging mitigation solutions including split adjudication, and monitors the evolving regulatory landscape including state accumulator legislation and federal court rulings. This role has a direct patient contact component, communicating directly with patients regarding coverage investigations, insurance benefit navigation, program eligibility determinations, and AFP awareness and navigation. This role serves as the executional arm of the initiatives to empower patients understanding and response to coverage determinations, providing personalized counseling to patients prescribed Rezurock, on all aspects of access — from understanding their insurance benefits and navigating prior authorizations, to appealing coverage denials, transitioning between financial assistance programs, and advocating for their legitimate commercial coverage in AFP situations. The Director coordinates hub communication with payers and patients, Field Reimbursement Manager (FRM) communication with providers and academic medical center pharmacies, and ensures visibility of access barriers across the patient, provider, and employer axis. This position reports directly to the Senior Director, Patient Services and Specialty Pharmacy Programs, and works cross-functionally with PSS TAs, Market Access, National Account Directors, Field Reimbursement Managers, Legal, Compliance, and brand commercial teams. Where applicable, AFP intelligence and case management best practices developed for Rezurock MyRock Assist may be shared with or applied to other PSS programs in an ancillary capacity. This role will be remote with up to 25% national travel.

Requirements

Bachelor's degree in life sciences, business, healthcare administration, or related field; MBA or advanced degree preferred
7+ years of experience within the pharmaceutical/biotech industry with a minimum of 3 years in patient services, case management operations, reimbursement hub operations, or payer/PBM operations
Deep expertise in commercial insurance structures, pharmacy benefit design, specialty drug access pathways, and the specialty pharmacy ecosystem, with demonstrated ability to support patients in understanding their insurance coverage for specialty care therapies
Demonstrated knowledge of AFP tactics, payer policies, TPA operations, and patient assistance program design and administration, including eligibility determination and financial assistance coordination
Experience leading or overseeing hub-level case management operations, including team development, workflow optimization, and performance monitoring
Demonstrated ability to conduct direct patient counseling on insurance coverage, program eligibility, prior authorization, appeals, and specialty pharmacy coordination
Experience with maximizer and/or accumulator programs and copay assistance optimization strategies
Strong understanding of HIPAA regulations, OIG guidance on patient assistance programs, ERISA, ACA Essential Health Benefit requirements, and pharmaceutical compliance requirements
Proven ability to manage complex stakeholder relationships across internal and external partners in a matrix organization
Exceptional analytical, problem-solving, and strategic thinking capabilities with the ability to translate case data and program metrics into actionable insights
Outstanding communication skills with demonstrated ability to counsel patients, educate and support HCPs, and present to senior leadership
Proficiency in case management systems, benefits verification tools, and data tracking/reporting platforms, with ability to leverage technology adaptation to optimize operations

Nice To Haves

Transplant or oncology therapeutic area experience, particularly in chronic graft-versus-host disease (cGVHD) or related conditions
Direct patient counseling, case management, or patient advocacy background with experience managing complex access cases
Payer, PBM, or TPA industry experience with knowledge of claims adjudication and formulary management
Hub vendor management experience, including business rule development, case manager training, and workflow optimization
Cross-functional leadership experience in matrix organizations with ability to influence without direct authority
Familiarity with electronic benefits verification (eBV) technology and AFP detection methodologies
Knowledge of state-level copay accumulator legislation and federal court rulings affecting patient access

Responsibilities

Lead AFP identification, assessment, and mitigation efforts across the Rezurock patient population, serving as the organization's primary subject matter expert on the AFP landscape and driving case management operations that support patients in navigating insurance coverage barriers
Develop and continuously refine AFP detection algorithms and hub screening methodologies, including deployment of targeted questions for hub case managers to uncover AFP indicators, applying workflow optimization principles to improve detection rates and reduce time to identification
Maintain and expand the comprehensive AFP/TPA database tracking employer plans, AFP vendors, tactics employed, and resolution outcomes
Coordinate cross-Sanofi AFP intelligence gathering across therapeutic areas, contributing to and drawing from enterprise-level AFP insights and working groups
Integrate Rezurock-specific patient and provider needs with enterprise AFP solutions, ensuring the transplant patient population is appropriately represented in cross-functional AFP strategy
Monitor evolving AFP tactics—including TPA-as-AFP models, accumulator-to-AFP models, and emerging schemes—and develop proactive countermeasures through intelligent risk-taking and trend analysis
Continuously refine hub business rules, enrollment forms, agent scripts, and case management workflows to improve AFP detection rates and operational efficiency
Coordinate with the hub vendor on AFP screening process improvements, holding suppliers accountable for identification accuracy and timeliness
Analyze AFP case data to identify trends, patterns, and emerging threats; produce regular intelligence reports for leadership and cross-functional stakeholders
Serve as subject matter expert on AFP regulations, litigation developments, ERISA implications, and industry best practices for mitigation
Lead and oversee all hub-level case management operations for the Rezurock MyRock Assist program, ensuring the case management team delivers consistent, high-quality, compliant patient support across the full patient journey from enrollment through sustained therapy access
Establish and maintain case management workflows, business rules, escalation protocols, and quality standards that drive operational excellence, efficiency, and patient-centered outcomes
Train, develop, and coach hub case managers on insurance coverage navigation, program eligibility determination, AFP identification, patient counseling techniques, and compliance requirements, fostering a culture of continuous improvement and innovation
Oversee case assignment, workload distribution, and capacity management across the hub case management team, ensuring timely case resolution and appropriate escalation of complex cases
Serve as the escalation point for complex cases that exceed standard hub case management capabilities, applying strategic management principles to drive resolution and inform protocol improvements
Conduct coverage investigations through direct patient contact under HIPAA authorization, assessing patient insurance status, benefit structure, AFP involvement, prior authorization requirements, and available coverage pathways
Provide comprehensive patient counseling on all aspects of insurance coverage and access, including explanation of benefits, pharmacy benefit design, specialty pharmacy requirements, prior authorization processes, step therapy requirements, and formulary placement
Determine and communicate patient eligibility for all MyRock Assist financial assistance programs — including PAP, Bridge, Quick Start, and IAP — ensuring patients and providers receive clear, accurate guidance on program terms, duration, qualification criteria, and next steps
Guide patients through the prior authorization and appeals process, providing education on appeal rights, supporting documentation requirements, and self-advocacy strategies; coordinate with hub and FRMs to facilitate timely resolution
Counsel patients on specialty pharmacy coordination, including specialty pharmacy selection, prescription transfer processes, cold chain and administration logistics, and ongoing refill support
Manage patient onboarding into the MyRock Assist program, ensuring seamless enrollment, benefits verification, and program initiation with minimal delay to therapy access
Oversee patient transitions between financial assistance programs — including Bridge to commercial coverage, PAP to IAP conversion, and AFP-driven program changes — ensuring continuity of care and clear patient communication at each transition point
Serve as the executional arm of the Patient Empowerment Initiative, delivering one-on-one guidance to AFP-affected patients and facilitating use of communication templates, tools, and educational materials
Develop and maintain patient empowerment resources including template letters to HR departments, insurers, PBMs, and TPAs; appeal guidance documents; prior authorization support materials; and AFP fact sheets
Track patient cases from initial enrollment through AFP identification, PAP denial, IAP conversion, appeal process, and commercial coverage activation, ensuring visibility to final therapy access outcomes
Collect patient and case manager feedback to continuously improve counseling protocols, hub workflows, and patient support resources, fostering innovation in patient support delivery
Monitor case management performance metrics including case resolution time, patient satisfaction, program enrollment rates, and access barrier resolution rates, translating data into actionable operational improvements
Manage and optimize the maximizer mitigation strategy through copay vendor partnership, building on a program that has delivered over $10 million in savings to date, with ongoing performance monitoring to sustain and expand results
Monitor maximizer program performance metrics and coordinate with copay vendor on continued optimization and expansion opportunities
Assess accumulator program impact on patient access and copay card utilization across the Rezurock patient population, leveraging trend analysis to inform strategic recommendations
Evaluate viability of accumulator mitigation solutions including split adjudication analysis, weighing cost, patient impact, and operational feasibility through an intelligent risk-taking framework
Develop strategies to preserve copay assistance value and ensure compliance assurance with state accumulator laws across 25+ states with active legislation
Monitor the regulatory landscape including the September 2023 HIV + Hepatitis Policy Institute v. HHS ruling, subsequent court developments, and state-level copay accumulator legislation
Provide strategic recommendations on copay program design adjustments in response to evolving accumulator and maximizer tactics
Coordinate with Legal and Compliance on accumulator mitigation approaches to ensure alignment with OIG guidance and pharmaceutical industry standards
Own comprehensive copay program strategy and optimization for Rezurock MyRock Assist, ensuring program design maximizes patient access while maintaining compliance assurance and sustainability
Oversee coordination of PAP, Bridge, Quick Start, and IAP programs as they relate to access barriers, ensuring seamless patient transitions between financial assistance programs and commercial coverage
Develop and refine eligibility determination frameworks that balance patient access with program sustainability, incorporating AFP intelligence and payer landscape insights
Monitor program utilization trends — including commercially-insured patients seeking PAP, AFP-driven enrollment patterns, and copay card redemption rates — and recommend strategic adjustments through ongoing performance monitoring
Ensure AFP-related PAP denials are processed efficiently with appropriate communication to patients, HCPs, and FRMs; support the IAP automatic conversion process for AFP-identified patients, ensuring compliance with Legal-approved protocols
Analyze the financial impact of AFP diversion on PAP program sustainability and commercial revenue, applying technology adaptation to improve tracking and reporting capabilities
Manage stakeholder relationships with Market Access and National Account Directors on payer policy requirements for AFP coverage investigations, ensuring access to accurate benefit information
Partner with Field Reimbursement Managers to provide AFP education, office support resources, and approved materials (including the AFP HCP Leave-Behind) for provider engagement; brief FRMs on individual patient cases and coordinate HCP office communication regarding AFP situations, Bridge availability, and coverage restoration pathways
Collaborate with the hub case management team at CoverMyMeds to refine AFP detection protocols, patient support processes, and case management workflows
Communicate with HCPs and Academic Medical Center pharmacies on coverage pathways, AFP awareness, and patient support resources
Liaise with Legal and Compliance on AFP mitigation approaches, patient communication materials, template review, and program eligibility frameworks
Support brand and commercial teams with access insights, patient journey intelligence, and AFP impact data to inform strategic decision-making
Participate in and contribute to cross-Sanofi AFP working groups and forums, sharing Rezurock MyRock Assist learnings and contributing to enterprise-level AFP coordination
Provide regular reporting to PSS leadership and brand leadership on AFP trends, mitigation outcomes, maximizer/accumulator performance, case management metrics, and patient access outcomes