Patient Case Manager, SAS & Patient Support, GTx and Hemophilia - Pfizer
New York City, NY
About the Job
SUMMARY
Patient Case Manageris a non-promotional support role (within Pfizer’s SpecialtyAccessSolutions & Patient Support team)thatfacilitatespatientaccess, support services,and coordination of the rare disease treatment journey. PCMs will support the Pfizer gene therapy portfolio with as well as rare diseases such as hemophilia. The PCM must be customer- oriented grounded in empathy, service, and excellence. The PCM must be compliance oriented toward Pfizer policies and protecting patient’s personal information.
PCMs will be held to high standards of customer service, engagement, empathy, and compliance. The PCM will be the primary point of contact for patients who have been ordered or prescribed a Pfizer Gene Therapy or hemophilia product. The PCM will be responsible for patient case management and be required to work with both internal and external stakeholders to assist in the patient journey. The PCM may engage with Pfizer Qualified Treatment Centers (QTCs), Hemophilia Treatment Centers (HTCs), Healthcare Providers (HCPs), care teams, and support staff as required. The PCM will coordinate closely with Pfizer’s Patient Services program representatives (both internal and external).
PCMs are dedicated to assisting patients with access to Pfizer’s gene therapy and hemophilia products and providing appropriate support throughout their journey.
The PCM will manage and oversee the process, timelines and activities to enable patient access to therapy and required support. This could include, enrollment & consent, benefits investigation/ verification, reimbursement & access support, order management, scheduling, device training and follow-up support, etc..
This individual will report directly to Director, Patient Case Manager (PCM), Specialty Access Solutions and Patient Support. The PCM will perform its duties while adhering to all Pfizer policies and compliance standards.
RESPONSIBILITIES
Responsibilitieswillinclude, but are not limitedto,thefollowing:
- Provide servicesagainstperformance benchmarks with a focus on a positive patient/ provider experience grounded inempathy
- PCM will provide support for all processes & activities to assist patients in their access to therapy, including patient enrollment, reimbursement, order management, and follow-up (relating to patients that are prescribed Pfizer’s gene therapy or hemophilia products and enrolled in the associated patient services program)
- Process applications, ensure consistency in patient details such as consent and enrollment forms, purchase order throughout the gene therapy treatment and resolve any discrepancies, if found, by conducting follow-ups with responsible parties PCMs will provide product and device education/trainingfollowing patient request.
- Supports patients, HTCs and QTCs for access-related communication, including helping to resolve reimbursement, coverage questions, and other topics such as financial assistance questions.
- Provides information and connection of patients with opt-in support services under the gene therapy patient services program
- Collaborate with internal and external functions to execute logistical and transactional activities related to drug product order management, patient access, and additional approved support services
- Provides a point of contact for long term follow-up and monitoring, as required, and determined by the label and/or regulatory authorities
- Connects the patient to the right resources at the right time
- Facilitate communication with vendors, HTC, QTC, patients/ caregivers and documents all interactions as required by the SOPs
- Participates in monitoring and quality improvement initiatives and training
- Adhere to required business rules, work instructions, and standard operating procedures (SOPs)
- Recommend process and efficiency improvements to constantly improve workflow and service levels
- Manage engagements using various technology platforms and customer relationship management (CRM) systems such as POLARIS
BASIC QUALIFICATIONS
Candidate demonstrates a breadth of diverse capabilities including: the ability to influence and collaborate with peers, develop and coach others, oversee and guide the work of external stakeholders to achieve meaningful outcomes and create business impact.
- Bachelor's degree minimum required in science or health-related field
- Valid and active licensure in applicable science or health-related field
- Minimum 10 years of total experience required in healthcare field (clinical, manufacturer, etc) including:
- Minimum 7 years of healthcare experience within the fields of care coordination / case management / reimbursement within tertiary care facilities or urgent care centers (experience in areas such as patient care coordination, reviewing & updating patients’ medical records, order placement, scheduling & logistics, follow-up)
- Minimum 2-3 years of medical billing or insurance claim management experience, preferably within the Pharmaceutical/ Biopharmaceutical sectors, Provider/Carrier Networks, or Government Agency. Reimbursement
- Experience in Access is a must
- Experience working with a Patient Coordinator / Nurse Coordinator / Patient Navigator
- Other licenses & certifications in areas such as clinical research, ethics/ compliance, HIPAA regulations
- Expertise in reimbursement activities, BI/BV, Prior Authorization, and Appeals Assistance preferred
- Priorexperiencein patient services for cell & gene therapies, bleeding disorders, or specialtypharmaceutical products (suchasbiologics)affectingpediatric and/or adult patent populations
PREFERRED QUALIFICATIONS
- Therapeutic area knowledge in rare & inherited diseases (Hemophilia A or B)
- Participation in clinical trials for Hemophilia and/or gene therapy; overseeing drug administration, research & data management
- Prior experience working in a specialty pharmacy/ working with payers
- Project Management / Operations management experience would be a plus: Experience driving mission-critical and time-sensitive programs, demonstrating exceptional communication & presentation skills, along with strategic planning and implementation success
- Demonstratedabilityto work in a highlyregulatedenvironmentand adhere tostrictcompanycomplianceguidelinesandprocedures.Proventrack record of collaborating broadly with a diverse range of customers,clients,andstakeholders.
Knowledge,Skills, and Abilities
Knowledge
- Understanding of genetherapy processes andrequirements a plus;abilitytolearn/ ramp up on newprocessesandplatforms
- Strongunderstanding of Rare Disease (a plus)reimbursement,governmentpayment systems (Medicaid),benefitsinvestigation/verification,PriorAuthorizationandappeals
- Workingknowledge of quality andregulatorypracticesinpharmaceuticalindustry
- Workingknowledge of Microsoft productsincludingWord,PowerPoint,Project,Excel,andanyother project / workflowmanagementtoolssuchas CRMs
Skillsetsand Abilities
- Problemsolvinganddetail orientation
- Project management and logistical skills
- Excellent communication skills, both written and verbal, to facilitate communication and escalations between internal and external stakeholders
- Problem solving and Case/ Project management skills
- Customer engagement and relationship building skills
- Ability to lead, motivate and coordinate cross-functional teams
- Ability to effectively use automated systems and computerized applications
Other Job Details:
- Last Date to Apply for Job: November 6th, 2024
- NOT eligible for Relocation Package
- Candidates located within Central time zone will be preferred
- Eligible for employee referral bonus
#LI-PFE
The annual base salary for this position ranges from $149,200.00 to $248,600.00. In addition, this position is eligible for participation in Pfizer’s Global Performance Plan with a bonus target of 20.0% of the base salary and eligibility to participate in our share based long term incentive program. We offer comprehensive and generous benefits and programs to help our colleagues lead healthy lives and to support each of life’s moments. Benefits offered include a 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution, paid vacation, holiday and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and vision coverage. Learn more at Pfizer Candidate Site – U.S. Benefits | (uscandidates.mypfizerbenefits.com). Pfizer compensation structures and benefit packages are aligned based on the location of hire. The United States salary range provided does not apply to Tampa, FL or any location outside of the United States.
Relocation assistance may be available based on business needs and/or eligibility.
Sunshine Act
Pfizer reports payments and other transfers of value to health care providers as required by federal and state transparency laws and implementing regulations. These laws and regulations require Pfizer to provide government agencies with information such as a health care provider’s name, address and the type of payments or other value received, generally for public disclosure. Subject to further legal review and statutory or regulatory clarification, which Pfizer intends to pursue, reimbursement of recruiting expenses for licensed physicians may constitute a reportable transfer of value under the federal transparency law commonly known as the Sunshine Act. Therefore, if you are a licensed physician who incurs recruiting expenses as a result of interviewing with Pfizer that we pay or reimburse, your name, address and the amount of payments made currently will be reported to the government. If you have questions regarding this matter, please do not hesitate to contact your Talent Acquisition representative.
EEO & Employment Eligibility
Pfizer is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability or veteran status. Pfizer also complies with all applicable national, state and local laws governing nondiscrimination in employment as well as work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Pfizer is an E-Verify employer. This position requires permanent work authorization in the United States.
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