Case Manager, TEPEZZA
Working at Horizon is more than a job - it's personal. For us, success is measured by the numbers that matter most - the number of lives we touch, the number we change and those we work tirelessly to help save. We're a team of agile, out-of-the-box thinkers who are inspired to do more because we know we're a part of something bigger. We strive to build meaningful careers at a company whose values we share because when we live up to our potential, we help others live up to theirs.
The Case Manager works in a highly visible, team and collaborative environment working with the reimbursement HUB, Patient Access Managers (PAMs) and Specialty Pharmacy. The Case Manager will work with patients, providers, partners and insurance companies to address insurance challenges, which may include prior authorizations, reauthorizations, insurance changes, and appeals. The Case Manager will manage a caseload and will work within the pre-determined process to gain access to the prescribed therapy, troubleshooting issues with insurance authorization and distribution of therapy. The Case Manager is accountable for providing exceptional customer service, at all touch points. The ability to anticipate challenges and address them understanding the time sensitivity of each case. The Case Manager must listen to and support patients and medical professionals, addressing their specific needs, providing friendly, courteous, professional and well-informed answers and solutions to their questions and needs. The Case Manager will develop and maintain relationships with patients and providers supporting therapy adherence. The Case Manager must be able to support regional geographies and time zones.
- Day to day oversight and awareness of patient customer service issues with insurance, the specialty pharmacy, and patient support programs
- Work closely with the Reimbursement Team, PAMs, the hub, pharmacy, and the patient/family to case manage all steps required to gain access to therapy
- Partner with Safety and Pharmacovigilance and report adverse events and product complaints through medical information
- Maintain case history for all U.S. patients, entering relevant notes from the hub, the pharmacy, calls to insurance, patient support programs, physicians and nurses, and the patients and families
- Maintain and update patient status to track reimbursement and shipping status of U.S. patients
- Triage, troubleshoot and resolve initial and ongoing reimbursement issues (PAs, denials, appeals, reauthorizations, overrides, billing problems)
- Liaise with medical offices as necessary to obtain insurance authorizations
- Counsel patients and family on insurance and reimbursement options
- Identify general and specific adherence trends and suggest appropriate action
- Daily interaction with sales representatives, patient services support and medical affairs to ensure current and accurate communication on the status of insurance approvals and reauthorizations
- Assist in developing strategy, manage, track, and report on Open Enrollment efforts annually to ensure every patient has access to adequate insurance
- Advise patients and families on insurance, financial assistance and therapeutic access programs
- Attend patient meetings, industry conferences and sales meetings
Qualifications and Skills Required:
- High school diploma required; Bachelor's Degree preferred.
- 5+ years of experience in the pharmaceutical industry.
- 2+ years prior experience as a case manager.
- Buy and bill experience required.
- Scientific or nursing background a plus.
- Excellent communication skills and commitment to customer service.
- Ability to effectively resolve hurdles across multiple cases at the same time.
- Ability to learn product and disease information, familiarity with HIPAA and FDA.
- Ability to manage communication with case managers and sales reps across multiple geographies and time zones.
- Up to 20% travel required.
- Proficient in Microsoft Office.
- Professional demeanor.
- Self-starter attitude.
- Strong interpersonal skills.
- Excellent written and verbal communication skills.
Horizon Core Values & Competencies:
- Manages Ambiguity
- Strategic Mindset
- Demonstrates Self-awareness
- Cultivates Innovation
- Develops Talent
- Drives Results
- Ensures Accountability
- Decision Quality
- Instills Trust
Horizon Therapeutics plc does not discriminate on the basis of race, color, religion, gender, sexual orientation, national origin, age, disability, veteran status, or any other characteristic protected by law. It is our intention that all qualified applications are given equal opportunity and that selection decisions be based on job-related factors. Any individual, who, because of a disability, needs accommodation or assistance in completing this application or at any time during the application process, should contact the Human Resources Department.