Rare Disease Case Manager/Atlanta

UCB • Atlanta, GA

6h • Remote

About The Position

The Rare Disease Case Manager serves as a subject matter expert on access & reimbursement who has extensive expertise in navigating insurance and access-related barriers. This role is designed to help patients gain access to prescribed UCB rare disease products and patient support, serving as the escalation point for difficult access related patient cases. This individual will share insights and collaboratively coordinate services with internal and external program partners. This role requires significant knowledge in the market access and reimbursement landscape encompassing procurement, payer policies and coverage, benefit design, prior authorizations, appeals, exceptions, denials, coding and payer payment guidelines, site of care differences and nuances.

Requirements

• Bachelor’s degree
• 8-10 years of experience in pharma, biotech, or healthcare space
• 5+ years of Case manager experience supporting market access, site of care selection
• 5+ min yrs of excellent working knowledge of evolving reimbursement landscape and the practice management environment
• Ability to Travel minimum of 20%

Nice To Haves

• Masters Preferred, or extensive relevant experience
• Rare disease and/or infusion experience
• Nursing degree/healthcare clinical experience
• Above-average skills with technology, including ability to quickly learn and accurately utilize contact center systems, CRM, and virtual platforms
• Experience in managing access complexities associated with a new to market medication
• Experience with specialty pharmacy products / products acquired through specialty pharmacy networks or specialty distributors (buy and bill)
• Close connectivity to the everchanging payor medical benefit policy arena
• Excellent virtual interaction and communication skills – both written and verbal
• Demonstrated flexibility, adaptability, and the ability to prioritize tasks and meet customer demands

Responsibilities

• Serve as expert on challenging market access patient cases specific to benefit verifications, product procurement processes, reimbursement information, billing, coding, and coverage details, after clinical decisions have been made by the prescriber.
• Coordinate the benefit verification referral process with UCB’s service center(s) and deliver timely and accurate follow up to account stakeholders to help ensure patient access to UCB medicines.
• Provide appropriate Appeal & Claims Denial Support
• Understand, provide quality control, communicate patient specific insurance coverage along with access and affordability options to team to support patients
• Establish self as national and regional expert on payer trends, product access, and reporting reimbursement trends and/or delays (i.e., denials, underpayment, access delays, etc.)
• Coordinate and collaborate with UCB Rare Reimbursement Executives, Care Coordinators, specialty pharmacies, needed HCP (Health Care Professional) offices, infusion providers, other key personnel on complex cases which require strategic intervention
• Manage and facilitate specialty pharmacy relationships, responsible for dispersing updates to team members and ensuring forward patient momentum
• Ensure understanding of the buy and bill reimbursement process, specialty pharmacies practices, field reimbursement support activities, and patient support programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level