Case Manager; Bi-Lingual

Location: Greater Boston Area

Role Type: Hybrid

The Case Manager serves as the primary point of contact for patients, guiding them compliantly through insurance coverage and reimbursement processes to support timely and affordable access to prescribed therapy. This role delivers a high-touch, personalized experience by providing education, coordination, and problem-solving to address patient and provider needs, obtain coverage approvals, and proactively remove access barriers. Case Managers work within a matrixed environment, partnering with cross-functional teams to deliver a seamless, patient-centered experience.

• Serve as the primary point of contact for patients and caregivers, providing education, guidance, and ongoing support throughout the access and reimbursement process.
• Manage assigned cases with urgency and accountability to achieve timely, compliant access to therapy.
• Conduct benefit investigations and verify coverage; facilitate prior authorization, denial management, and appeals as needed.
• Support enrollment in financial assistance or affordability programs and coordinate with patients, payers, and partners to maintain continuity of care.
• Collaborate with healthcare provider offices, specialty pharmacies, payers, and internal stakeholders to resolve complex reimbursement or fulfillment challenges.
• Maintain working knowledge of payer policies, reimbursement pathways, and distribution channels to anticipate and address access barriers.
• Communicate clearly, compliantly, and compassionately with patients, caregivers, and healthcare provider offices regarding case status and available support.
• Document all case activities accurately and in real time within CRM and case management systems to ensure data quality and continuity.
• Share insights, identify trends, and contribute to process improvement and quality initiatives.
• Demonstrate professionalism, empathy, and proactive problem-solving while adhering to organizational policies, privacy standards, and regulatory requirements.

Education

• Bachelor’s degree required; advanced degree (e.g., MSW, MHA, MBA) preferred

Experience

• 7+ years of experience within healthcare or life sciences-related environments
• Minimum of 5 years of patient access, reimbursement, case management, or high-touch patient-facing experience

Language Requirement

• Bilingual in Spanish required (written and spoken fluency)

Skills & Competencies

• Strong understanding of health insurance benefits, payer policies, and reimbursement processes
• Demonstrated ability to coordinate across healthcare stakeholders, including providers, pharmacies, and financial assistance partners
• Proven experience resolving complex access issues such as benefit verification, prior authorization, and appeals
• Excellent communication, empathy, and critical thinking skills
• Strong organizational, time management, and documentation skills with high attention to detail
• Ability to collaborate effectively within a matrixed, cross-functional environment
• Up to 15% domestic travel may be required

• Experience supporting patient services within pharmaceutical, biotechnology, or healthcare organizations
• Familiarity with multiple distribution or fulfillment channels
• Experience using CRM platforms (e.g., Salesforce)