Case Management Specialist - East (South Fl, PR)

Job Title:       Case Management Specialist

Reports To:   Division Director, Case Management

Location:Cambridge, MA 

Department:  Patient Support Services, Rare Disease

Job Purpose:

Across the Rare Diseases our ‘one team, common goals, single mission’ new go-to-market (GTM) approach is leading the way.

This new Rare Diseases GTM model highlights the need to reinvent and evolve the Case Management (CM) role with more accountability, responsibility, and strategic intent than ever before. The new CM will be required to elevate performance, skills, knowledge, behaviors and contribute a critical component of our new play to win elite approach. 

We have elevated the CM role to include: Building expertise for 7 brands, 5 therapeutic areas, engage in account strategy and planning with galaxy and constellation teams (monthly), engage in launch preparations with insights and expertise,understanding market conditions that impact the patient journey (i.e. payer coverage, government, legislation, Pharma,industry, access),understanding rare competitive products, advise the cross functional teams on the patient perspective, consider the account perspective, and developing skills sets that will allow them to compliantly bring patient insights back to leadership reducing the need for external insights gathering. CM will communicate key performance indicators (KPIs) to measure success and impact (reported monthly).

The Case Management Specialist (CMS) willbe responsible for supporting Rare Disease patients and families through comprehensive care coordination and case management expertise aligned to their assigned account territory. 

The CMS will develop and execute personalized care plans to identify and address barriers to treatment, foster ongoing relationships with patients, caregivers, healthcare providers, and other key stakeholders. The CMS proactively identifies and mitigates access barriers, coordinates with insurance providers, specialty pharmacies, and local resources as needed. Additionally, they assist in facilitating insurance approvals for both the product and administration, ensuring seamless collaboration across multiple functions to maintain a cohesive support network. The SACMS works collaboratively in a team environment with internal cross-functional team members to help facilitate and optimize patient care. 

Job Responsibilities:

• Act with a sense of urgency and purpose, lead the case management process, while balancing the needs of individual patients to align with the business objectives of Sanofi, and the Rare Disease organization.

• Assess individual patients’ access needs and develop an action plan that provides for the initiation and continuation of treatment. 

• Help facilitate insurance approval for SanofiRare Disease therapies.

• Educate patients, caregivers, health care providers, and others regarding insurance options, requirements or limitations, case management services, and steps needed to gain product and administration approval.

• Maintain 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.

• Enroll patients who qualify into the appropriate financialassistance program as needed/required. 

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

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

• Exhibit 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.

• Establish and maintain 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, insurance companies, specialty pharmacies, infusion site staff and office coordinators.  

• Attend patient meetings, site visits/calls, conferences, and trade shows to educate individuals regarding services and other approved case management topics. Represent Sanofi in all venues in a professional manner.

• Raise own performance expectations and goals to support the account teamsdemonstrating personal and team growth.

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

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

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

• Consistently maintain and document accurate data, including insurance, coverage approvals, on-going coverage requirements, and all patient and provider interactions.

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

• Utilize professional communication to foster strong working relationships with internal and external colleagues.

• Provide caseload coverage outside of assigned territory as needed.  

• Ensure compliance with Sanofi policies. 

• Working hours must align to the geography you support 

Qualifications:

• Bachelor’s Degree required. 

• 3-5 years of patient-facing or high touch customer interaction experience required. 

• 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 with a patient centric approach. 

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

• Robust computer literacy skills including data entry and MS Office-based software programs. 

• Possesses strong business acumen and strategic thinking skills.

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

• Ability to travel required, ~10%, possibly weekends.

• This position is based in Cambridge, MA.  Applicants must reside in a location which would allow them to comply with Sanofi’s hybrid work policy. 

Preferred Qualifications:

• Bi-lingual; Spanish language skills preferred. 

• Salesforce CRM experience 

• Direct experience in the case management, insurance, or healthcare systems fields

• Pharma/biotech patient services experience

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