Director, Case Management Specialist

Job Title:  Director, Case Management Specialist

• Location: Cambridge, MA                                          

About the Job

Lead the team that is responsible to provide best-in-class personalized patient services to ensure a positive patient experience in support of Sanofi General Medicines business priorities.  Driven by the complexity of patient identification, treatment administration intricacies, and access gateways, this role must coordinate both internal and external care teams in the overall patient journey. The Case Management Specialist team will support Stage 2, Type 1 diabetes patients and families through care coordination and case management. In this high touch role, the team will assist patients and caregivers with accessing Sanofi’s FDA-approved 14-day T1D infusion therapy. This leader will lead the case managers that are responsible for facilitating insurance approvals for both the product and administration, successfully collaborating across multiple functions, and coordinating care to ensure a cohesive support network. The successful Case Management Specialist will align internal FRM, TEM, and CORE team activity with the patients care team and providers including treating physician, administering location, payer, and specialty pharmacy to ensure successful treatment. The Case Management Specialist will be the central point of contact that will develop and execute personalized care plans to address patient barriers to treatment, providing relevant program and process education, resources, and coordination along the patient journey.  

This team director is responsible for overseeing a team, guiding and training personnel, developing policies, procedures, and KPIs, establishing and adhering to budgets, communicating with physicians, staff, and patients as applicable, coordinating with third-party vendor partners, working collaboratively with Specialty Pharmacy partners, and develop and execute personalized care plans to address patient barriers to treatment. Provide best-in-class patient services to ensure a positive patient experience and support Sanofi business priorities.

We are an innovative global healthcare company, committed to transforming the lives of people with immune challenges, rare diseases and blood disorders, cancers, and neurological disorders. From R&D to sales, our talented teams work together, revolutionizing treatment, continually improving products, understanding unmet needs, and connecting communities. We chase the miracles of science every single day, pursuing progress to make a real impact on millions of patients around the world.

About you

Job Responsibilities:

• Lead team responsible for:

• Acting with a sense of urgency and purpose, leading the case management process, while balancing the needs of individual patients to align with the business objectives of Sanofi, the General Medicines Business Unit and Specialty Care Patient Support Services 

• Serving as point of contact and champion for patient from enrollment through to infusion 

• Assessing individual patients’ insurance coverage options or limitations and requirements, identifies appropriate resource plans and advocates on patient’s behalf to ensure successful initiation of T1D treatment.  

• Educating patients, caregivers and health care providers on T1D product coverage based on patient benefits and the steps needed to gain product and administration approval 

• Maintaining comprehensive understanding of the reimbursement process, navigation of health care systems, billing/coding guidelines, insurance plans, payer trends, internal and external patient assistance programs, and related resources. 

• Coordinating with different sites of care, including infusion centers

• Managing the transition from infusion site to in-home infusion therapy as appropriate

• Enrolling eligible patients into appropriate financial assistance programs as needed/required.  

• Maintaining up-to-date knowledge of the resources available at the regional level as well as market landscape and applies this knowledge in way that best supports patient access to therapy. 

• Compliantly coordinating the exchange of patient-related information with internal and external stakeholders. 

• Exhibiting initiative and leadership within the cross-functional regional team. Able to consistently identify complex patient specific issues and develop action plans accordingly. Demonstrates accountability for action plan execution, and energetically drives for success and results. 

• Establishing and maintaining professional and effective relationships with all internal and external customers and stakeholders, including but not limited to case management team and patient support services colleagues, medical, sales, market access, pharmacovigilance, specialty pharmacies, healthcare providers and staff, and infusion sites.   

• Attending meetings and conferences to educate individuals regarding services and other approved case management topics. Represent Sanofi in all venues in a professional manner. 

• Raising own performance expectations and goals to support entrepreneurial approach to the growth of the team and the business. 

• Demonstrating and maintaining a high level of business acumen, understanding of Sanofi’s business model, and the role of the case manager and patient support services team in driving initiatives to meet goals.  

• Demonstrating innovation by consistently monitoring systems, processes, and potential gaps, offering new ideas and solutions to elevate the support program. 

• Effectively sharing reimbursement and other knowledge with PSS members through orientation training, case studies, consultation for complex cases, and special projects as requested.   

• Consistently documenting and maintaining accurate data, including insurance, coverage approvals, on-going coverage requirements, and all patient, caregiver, provider and matrix team interactions. 

• Demonstrating proficient in use of CRM tool to document work.  Consistently leverages CRM reporting tools and data analytics to make strategic territory decisions while prioritizing patient and customer needs.  

• Providing caseload coverage outside of assigned territory as needed.   

• Complying with Sanofi policies.  

• Recording and reporting Adverse Events and Product Complaints

• Assessing risk and evaluating potential for patient case deviation and communicating and suggesting contingencies.  

Additional Leadership responsibilities include:

• Hiring, training, onboarding, and performance management for a team of case managers

• Handling case management process, balancing the needs of individual patients, Patient services priorities and aligning with the business needs/objectives of Type 1 businesses

• Ensuring close and compliant coordination and partnership with other Field Matrix teams supporting Tzield

• Balancing caseload coverage and adjusting territory workload as needed. 

• Completing quality call calibration and manage deviations

• Ensure compliance with Sanofi policies

Qualifications: 

• Bachelor’s Degree (general business, health sciences, public policy, or other related degrees)

• 5+ years of patient-facing or high touch customer interaction/case management experience required. 

• 5+ years of team lead or supervisory experience

• In-depth understanding of health insurance benefits, relevant state and federal laws and insurance regulations. 

• Excellent written and oral communication, mediation, and problem-solving skills, including the ability to connect with patients, caregivers and providers. 

• Experience and demonstrated success working in a complex matrix to accomplish goals 

• Strong people skills that demonstrate flexibility, persistence, creativity, empathy and trust.   

• Computer literacy skills including data entry and office-based software programs. 

• Ability to identify and handle sensitive issues, working independently and collaboratively within teams.   

• Knowledge of guidelines relating to compliant medical communications 

• Ability to travel, up to 10%. 

Preferred Qualifications: 

• Bi-lingual; Spanish language skills preferred 

• Salesforce CRM experience  

• Pharma/biotech patient services and specialty product experience 

• Experience with complex medical payer policy requirements and coordination of multiple prior authorization needs for one case  

• Infusion experience preferred 

• Home care coordination experience preferred 

• Buy & Bill and white bag experience preferred 

• Experience with varied methods of drug acquisition and administration 

Why Choose Us?

• Bring the miracles of science to life alongside a supportive, future-focused team.

• Discover endless opportunities to grow your talent and drive your career, whether it’s through a promotion or lateral move, at home or internationally.

• Enjoy a thoughtful, well-crafted rewards package that recognizes your contribution and amplifies your impact.

• Take good care of yourself and your family, with a wide range of health and wellbeing benefits including high-quality healthcare, prevention and wellness programs and at least 14 weeks’ gender-neutral parental leave.

Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.

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