Rare Disease Case Manager

Overview

Make your mark for patients

We are looking for a Rare Disease Case Manager for the Central Region who is adaptable, highly collaborative and solution oriented to join us in our Patient Support Program. This position can be remote/virtual, based in the US supporting the Central & Eastern time zones. The standard hours of operations for this role are 8:30am to 5:00pm CST or EST depending on place of residence.

This remote role requires twenty percent face-to-face interactions and can be based in the following metropolitan areas and subject to change:
Florida, Atlanta GA, Lexington KY, Memphis & Knoxville TN, and Birmingham AL
.

The Rare Disease Case Manager serves as a subject matter expert on access & reimbursement with 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.

• Case Managers
• Rare Reimbursement Executives
• Care Coordinators
• Cross functional partners including specialty pharmacies, HUB partners, payers, and as needed, physicians, office coordinators, nurses and pharmacists

• 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, and communicate patient specific insurance coverage along with access and affordability options to the team to support patients.
• Establish self as national and regional expert on payer trends, product access, and reporting reimbursement trends and/or delays (e.g., denials, underpayment, access delays).
• Coordinate and collaborate with UCB Rare Reimbursement Executives, Care Coordinators, specialty pharmacies, needed HCP offices, infusion providers, and other key personnel on complex cases which require strategic intervention.
• Manage and facilitate specialty pharmacy relationships, 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.

• 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+ years of excellent working knowledge of evolving reimbursement landscape and the practice management environment
• Ability to travel a minimum of 20%

• Masters preferred, or extensive relevant experience
• Rare disease and/or infusion experience
• Nursing degree/healthcare clinical experience
• Strong technology skills, including the ability to learn and use contact center systems, CRM, and virtual platforms
• Experience managing access complexities for new-to-market medications
• Experience with specialty pharmacy products and networks (buy and bill)
• Close connectivity to the evolving payor medical benefit policy arena
• Excellent written and verbal communication, especially in virtual interactions
• Demonstrated flexibility, adaptability, and the ability to prioritize tasks

This position offers a reasonably anticipated base salary range of $125,600 - $164,900 annually. The actual salary offered will consider related knowledge, skills, experience and location…