Reimbursement and Access Case Manager

Alkermes

12h

About The Position

The Reimbursement and Access Case Manager (RACM) works on the Alkermes Patient Access Services (PAS) team, which supports patients seeking access to Alkermes products through reimbursement and access education, refill reminders, financial assistance coordination, and support locating follow-on providers for site-of-care transitions. The RACM is a single point of contact for healthcare providers, vendor partners, insurance companies, and other customers, providing education and logistical support. The role serves as a subject matter expert on reimbursement, local and regional health plan policies, coverage requirements, pharmacy coordination, and other issues affecting product fulfillment. The RACM also partners with internal Alkermes stakeholders and PAS Nurse Coordinators to support transitions from inpatient or residential care to outpatient treatment. The position involves varied shifts to support operations from 8:30 a.m. to 8 p.m. ET, with the description also listing hours of 8:30 a.m. to 5 p.m. Approximately 15–20% overnight travel is required for field rides and customer site visits, hub vendor partner visits, and sales meetings. Some flexibility may be requested to provide backup coverage during program hours.

Requirements

Excellent active listening and written and verbal communication skills.
Ability to quickly and accurately understand callers’ needs and provide responses tailored to those needs while following program and compliance guidelines.
Ability to document call details accurately and maintain data integrity.
Ability to multitask, solve problems, and work independently.
Ability to plan, prioritize, execute, follow up, and anticipate problems effectively.
Ability to manage multiple projects in a fast-paced, deadline-driven environment.
Ability to work collaboratively across stakeholder groups and as an independent contributor.
Prior reimbursement experience and ability to explain complex reimbursement and fulfillment scenarios and solutions to patients and medical professionals.
Ability to think critically and address customer needs and barriers to product fulfillment.
Ability to accommodate approximately 15–20% overnight travel.
Proficiency in Microsoft Outlook, Word, Excel, and PowerPoint.
Minimum of 3 years of case management experience or experience working in a reimbursement hub program is preferred.
Extensive knowledge of health plan reimbursement requirements for specialty injectable products covered by medical (AOB) and pharmacy benefits.
Working knowledge of the compliance and regulatory environment for pharmaceutical manufacturers.
Experience understanding the importance of reimbursement hub metrics and operations in the pharmaceutical industry.

Nice To Haves

Bachelor’s degree preferred.
Experience working in a high-volume patient services program preferred.
Minimum of 3 years of case management experience or experience working in a reimbursement hub program preferred.

Responsibilities

Act as a single point of contact and subject matter expert regarding acquisition, fulfillment, and reimbursement for Alkermes products while providing high-quality customer service.
Develop working relationships with internal and vendor teams to coordinate support for healthcare providers and patients.
Provide updates and account information to internal stakeholders, including field sales, national accounts, and field reimbursement managers.
Understand Alkermes PAS processes and database, including data elements, case statuses and outcomes, documentation requirements, and program metrics.
Accurately document call details, follow-up actions, and other relevant information in the Alkermes PAS database.
Learn reimbursement and coverage requirements for health plans in assigned geographic territories and help troubleshoot and resolve ongoing issues.
Identify and escalate customer concerns and program trends to the patient access services management team and reimbursement access specialists.
Assess patient enrollment for Alkermes financial assistance programs, including copay savings and patient assistance programs.
Coordinate with PAS Nurse Coordinator teams to support patient transitions from inpatient or residential sites of care to outpatient treatment.
Provide backup support for other case managers and patient services team members.
Adhere to Alkermes standard operating procedures and compliance requirements.