Case Manager

Location: Greater Boston Area

Role Type: Hybrid

Position Summary

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 through education, coordination, and problem-solving to address patient and provider needs, obtain coverage approvals, and proactively mitigate access barriers. Case Managers work within a matrixed environment, partnering with field-based teams, operations, and cross-functional stakeholders to ensure a seamless, patient-centered experience.

Key Responsibilities

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

Qualifications

Education

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

Experience

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

Skills & Competencies

• Strong knowledge of health insurance benefits, payer policies, and reimbursement processes
• Proven ability to coordinate across multiple healthcare stakeholders, including providers, specialty pharmacies, and financial assistance partners
• Demonstrated 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 in a matrixed, cross-functional environment
• Up to 15% domestic travel may be required

Preferred Qualifications

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