Patient Services Case Manager (Waltham, MA/ Remote)

Ardelyx

Waltham, MA, US
  • Job Type: Full-Time
  • Function: Marketing/PR/Product Mktg
  • Post Date: 03/19/2021
  • Website: ardelyx.com
  • Company Address: 34175 Ardenwood Blvd., Fremont, CA, 94555

About Ardelyx

Ardelyx is focused on enhancing the way people with kidney and cardiovascular diseases are treated by developing innovative first-in-class medicines.

Job Description

Ardelyx is a publicly traded biotech company focused on improving the lives of patients by developing and commercializing first-in-class targeted therapies that advance patient care. Using our discovery model, Ardelyx scientists have characterized new biological mechanisms and pathways that have enabled us to develop a pipeline of drug candidates to manage complications related to kidney and cardiovascular diseases. Our lead candidate, tenapanor, is a first-in-class small molecule therapy for the treatment of hyperphosphatemia in adult patients with chronic kidney disease on dialysis. If approved, tenapanor could completely change the treatment paradigm in a disease state with significant unmet need.  We are advancing the build of our commercial organization to be prepared for launch of tenapanor in mid-2021.

 

Patient Services Case Manager

The Patient Services Case Manager will be an integral member of the company’s Patient Services reimbursement hub team.  This position is responsible for ensuring access to and affordability of Ardelyx’s first commercially launched product, tenapanor. Success in this position will focus on enhancing and optimizing the patient and prescriber experience during the entire treatment cycle, from initial prescription through to the maintenance phase of therapy.  The Patient Services Case Manager will serve as the primary point of contact for all stakeholders who engage with our patient services department.  This will include providing concise and professional communication to both internal and external parties regarding case status updates, including reimbursement issues, prior authorization/appeals support, care coordination, and education on available financial assistance programs offered by Ardelyx. The Patient Services Case Managers will interact directly with external clients such as specialty pharmacies, payers, certain vendors, as well as internal teams as needed. The role also functions as a subject matter expert on reimbursement support services within their assigned territory. This position reports to the Senior Manager of Patient Services.

Responsibilities:

  • Acts as the primary point of contact and voice of Ardelyx regarding the patient services hub program, handling inbound and outbound communications for all patient and healthcare provider (HCP) interactions.
  • Maintains comprehensive understanding of the pharmacy benefit/reimbursement process, billing nuances, insurance plans, payer trends, financial assistance programs, charitable access, and related resources.
  • Collaborates across internal departments (Sales, Marketing, Market Access), serving as a subject matter expert to their assigned territory. Provides presentations and Q&A to key stakeholders regarding the Ardelyx Patient Services program, trends, and overall health of their given territory helping to inform decisions organization-wide.
  • Supports the execution of the commercial strategy set forth by building reimbursement confidence and understanding with HCPs and assisting in patient pull though efforts.
  • Consistently demonstrates the ability to prioritize and balance the needs of patients, HCPs, and key stakeholders by ensuring that all cases are worked on in an efficient and compliant manner in accordance with all company policies and procedures.
  • Provides exceptional service to all by ensuring appropriate and consistent communication and collaboration with patients, HCPs, specialty pharmacies, and payers throughout the case life cycle.
  • Evaluates needs of HCP offices, including dialysis clinical staff, and develops action plans to incorporate best practices for coordinating the exchange of all patient-related information to streamline access for tenapanor. Assesses patient prescription benefits and works to resolve all access and affordability barriers.
  • Assists in obtaining insurance approval for therapy, and proactively plans to mitigate delays in coverage by working with the patients and caregivers, healthcare providers, insurance companies, and specialty pharmacies.
  • Serves as an advocate for the patients, HCPs, and caregivers throughout the tenapanor journey.
  • Educates patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate therapy, case management services and relevant disease/product information as necessary.
  • Processes all Patient Assistance Program (PAP) requests in a timely fashion as well as PAP re-approval verification for continued eligibility.
  • Is cross-trained to perform various administrative services, including but not limited to, case creation, data entry, benefit investigations/verification for patients, prior authorization and appeals support, and commercial copay benefit design application.

Qualifications:

  • B.S. preferred; An Associate Degree or equivalent from a two-year college or technical school plus 5+ years’ relevant experience will be considered.
  • Prior 3+ years’ experience in specialty pharmacy, hub reimbursement services, social work, dietary science, or a related field.
  • Direct experience with nephrology products or providers preferred.
  • Self-motivated, high degree of initiative, high achievement and superb attention to detail.
  • Strong verbal and written communications skills and a demonstrated ability to present clearly and persuasively.
  • Ability to independently manage case load and prioritize work. Must have strong time management skills in order manage deliverables while maintaining meticulous attention to detail.
  • General knowledge of HCP office processes regarding patient flow, prescription flow and clinic office operations.
  • Outstanding customer service, interpersonal, and communication skills with the established ability to build productive internal/external working relationships
  • Strong functional knowledge of health insurance and benefits (i.e. Medicare Part D, commercial and Medicaid) with a solid understanding of insurance eligibility, benefit verification, prior authorization processes, reimbursement coverage, appealing insurance denials, application of financial assistance, co-pay support and bridge programs.
  • Understanding of the legal and regulatory environment impacting patient services along with demonstrated integrity on the job.
  • Working knowledge of pharmaceutical manufacturer compliance requirements and patient confidentiality (HIPAA regulations).
  • Ability to exhibit a leadership role within the assigned territory and uphold Ardelyx core values (dedicated, fearless, passionate, and inclusive).
  • Strong compliance mindset, demonstrating clear understanding of all patient privacy laws
  • Prior experience working with CRM system(s).
  • Ability to proficiently use Microsoft Excel, Outlook and Word.
  • Desire to work in a fast-paced “roll up the sleeves” environment.
  • Must be authorized to work in the U.S. for any employer without the need for sponsorship.

 

Work Environment:

  • Ideal candidate will be based near Waltham, MA. Remote candidates may also be considered.
  • Willingness to travel up to 10% of time within the U.S.

As a member of the Ardelyx team, you will play a key role in developing and bringing to market first-in-class medicines to better the lives of underserved patients.  It’s the patients in need that motivate and inspire us to be relentless and work hard every day. They push us to maintain a clear focus on scientific and clinical integrity with a commitment to medical innovation so that we can deliver exceptional medicines.  We are different for good.

Ardelyx, Inc. is an Equal Opportunity Employer

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.