Reimbursement and Access Case Manager

Alkermes•Waltham, MA

1d•$60,000 - $75,000

About The Position

The Reimbursement and Access Case Manager (RACM) is a single point of contact for healthcare providers, vendor partners, insurance companies, and other customers seeking access to Alkermes products. The RACM provides education and logistical support related to product acquisition, fulfillment, and reimbursement, and serves as a subject matter expert on reimbursement, local and regional health plan policies, coverage requirements, pharmacy coordination, and other topics affecting product fulfillment. The role partners with internal stakeholders—including sales, national accounts, and field reimbursement resources—and works with Patient Access Services Nurse Coordinators to support patients transitioning from inpatient or residential care to outpatient treatment. The RACM documents customer interactions and follow-up in the PAS database, supports financial assistance enrollment, and helps resolve access barriers. The role involves approximately 15–20% overnight travel for field rides and customer site visits, vendor site visits, and sales meetings. Working shifts vary to support operations from 8:30 a.m. to 8 p.m. ET, with the posting also specifying hours of 8:30 a.m. to 5 p.m.; flexibility may be requested for backup coverage. A bachelor’s degree is preferred, and the role requires a minimum of three years of case management experience or experience in a reimbursement hub program (preferred). The annual base salary range is $60,000–$75,000, with eligibility for an annual performance pay bonus.

Requirements

Quickly and accurately understand the needs of callers seeking information.
Excellent active listening and written and verbal communication skills.
Provide caller-specific responses while complying with Alkermes program and compliance guidelines.
Document call details accurately, maintaining data integrity for business analysis.
Ability to multitask, problem-solve, 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 collaborate across multiple stakeholder groups and work both as a team member and independent contributor.
Prior reimbursement experience and ability to communicate complex reimbursement and fulfillment scenarios and solutions to patients and medical professionals.
Critical-thinking and problem-solving skills to address customer needs and barriers to product fulfillment.
Ability to accommodate approximately 15–20% overnight travel for field rides, customer and vendor site visits, and sales meetings.
Flexibility to support varied shifts and backup coverage for operating hours from 8:30 a.m. to 8 p.m. ET.
Extensive knowledge of health plan reimbursement requirements for specialty injectable products covered by medical (AOB) and pharmacy benefits.
Working knowledge of compliance and regulatory requirements for pharmaceutical manufacturers.
Experience and understanding of reimbursement hub metrics and operations in the pharmaceutical industry.
Proficiency in Microsoft Outlook, Word, Excel, and PowerPoint.

Nice To Haves

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

Responsibilities

Serve as a single point of contact and subject matter expert on 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.
Learn and apply Alkermes PAS processes and database requirements, including data elements, case statuses and outcomes, documentation requirements, and program metrics.
Accurately document call details, follow-up actions, and other pertinent information in the Alkermes PAS database.
Build familiarity with health plan reimbursement and coverage requirements in assigned territories to 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 care to outpatient treatment.
Provide backup support for other case managers and patient services team members as needed.
Follow Alkermes standard operating procedures and compliance requirements.