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Case Management Specialist, Senior

Company Sanofi US
Location Cambridge, MA
Update 9 Day ago
Job Purpose

Exhibit a high level of case management expertise and demonstrated leadership skills. Utilize care coordination to address patient concerns; obtain insurance approval for enzyme replacement therapy and proactively plan for the maintenance of coverage by working with the patient, family, insurance company, physicians, workplace benefits administrators and persons from other areas of Sanofi Genzyme. Facilitate the case management process along the healthcare continuum.

Job Responsibilities

Manages the Care Coordination process while balancing the needs of individual patients with the business realities and necessities of Sanofi Genzyme and US Rare Disease.

Assesses patients’ needs and develops action plans that provide for the introduction and continuation of enzyme replacement therapy while coordinating the exchange of all patient-related information with internal and external customers

Maintains comprehensive understanding of the reimbursement process, billing/coding nuances, dose calculations, insurance plans, payer trends, financial assistance programs, charitable access, and related resources

Assists in obtaining insurance approval for enzyme replacement therapy, and proactively plans for maintenance of coverage by working with the patients and their family, healthcare providers, insurance companies, specialty pharmacies, and Sanofi Genzyme Colleagues.

Maintains up-to-date knowledge of the resources available at the regional level, including alternative resources, and applies this knowledge in way that best supports patient care

Educates patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate and maintain enzyme replacement therapy, case management services and relevant disease/product information as necessary.

Exhibits a leadership role within the optimization 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

Establishes and maintains professional and effective relationships with all internal and external customers including but not limited to care coordination colleagues, medical, sales, corporate accounts, Patient Advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators.

Attends patient meetings, site visits, conferences and trade shows to educate individuals regarding case management services. Represent Sanofi Genzyme in all venues in a professional manner.

Raises own performance expectations and goals to support entrepreneurial approach to the business

Demonstrates understanding of Sanofi Genzyme’s business model, and their role in commercializing the business

Consistently monitors systems and processes and recognizes when it is time to try new approaches

Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested.

Consistently maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions. Coordination of information with all customers is required.

Is proficient in the use of Salesforce and in producing data specific reports upon request

Minimum Requirements

Bachelor’s Degree in Health Care/Social Work/Nursing (or equivalent). Four to six years recent experience in the case management process. Experience should include but is not limited to home care management, case management review, utilization review, social service support, insurance reimbursement and patient advocacy. Industry experience preferred. In-depth understanding of health insurance benefits, relevant state and federal laws and insurance regulations. Developed communication, mediation, and problem solving skills. Experience with data entry/computer literate skills. Ability to identify and handle sensitive issues with opposing opinions, work independently and handle projects or multiple tasks. Ability to travel required, up to 25%, possibly weekends. Spanish speaking skills a plus.

Genzyme Corporation (a Sanofi company) 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. #LI-GZ #GD-SG

Sanofi is a global healthcare leader focused on patients' needs, engaged in the research, development, manufacturing and marketing of therapeutic solutions focused on patients’ needs. Sanofi has core strengths in diabetes solutions, human vaccines, innovative drugs, consumer healthcare, emerging markets and Sanofi Genzyme.
At Sanofi, our ambition is to be an integrated global healthcare company, focused on patients’ needs. Much more than just a leading pharmaceutical company, Sanofi is committed to transforming scientific innovations into solutions and services that protect health, enhance life, and respond to the needs of the 7 billion people in the world. We trust our ambition to guide and inspire us as we work to create a future with optimal health and wellness for everyone.