Lead Patient Navigator Social Worker

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Job Title: Lead Patient Navigator Social Worker 

POSITION SUMMARY: 

Under the general direction of Operations Management, the Lead Case Manager is responsible for managing, coaching, developing, directing, and leading a high performing team of field-based Case Managers who educate patients and their families on product access, reimbursement processes, and help with the management of therapy delivery. In addition, this role will work closely with patients, caregivers, and providers to help support a patient gain access to therapy and help ensure ongoing compliance with therapy.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Responsible for leading the execution of patient access-related strategies and objectives for all assigned therapies
• Collaborate with other program leaders as appropriate to develop new strategies that support both the launch of new therapies and/or advance patient access for existing therapies
• Work with and through Case Managers to ensure regional patient access performance meets or exceeds Regeneron company objectives. 
• Educate field-based teams, as appropriate, on patient access issues. 
• Implement Management by Objectives (MBOs) for each Case Manager to ensure team objectives are achieved. 
• Effectively coach, develop, motivate and monitor team performance to include regular and timely feedback, actionable development plans that nurture talent for increased responsibility, early identification of performance challenges or deficiencies and creation of action plans to address performance gaps. 
• Works closely with patients/caregivers and providers to gain access to therapy 
• Work with Specialty Pharmacy and Hub to obtain reimbursement coverage 
• Provide information to patient/caregiver on reimbursement options and financial assistance options 
• Manage transition to home therapy as appropriate. Work closely with specialty infusion pharmacies and nursing agencies to help coordinate reimbursement and supplies  
• Responsible for maintaining case history for all assigned patients in the CRM system 
• Help to resolve ongoing reimbursement issues (insurance changes, PA’s, other)  
• Work with Field Sales Reps and Market Access team  
• Answer patient and medical office inquiries, as appropriate, and help resolve customer problems related to access and reimbursement 
• Provide ongoing support by making regular calls and potentially scheduling in-person meetings with patients/families  
• Manage patient assistance requests and work with partners to process applications 
•  Provide backup coverage for program operations and covering Case Manager responsibilities in the event of planned/unplanned absences and support needs in excess of capacity in a given territory
• Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
• Performs other related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

•  Minimum 10+ years' experience in the pharmaceutical/healthcare industry  
• Minimum of 3+ years reimbursement management experience.  
• Minimum of 3+ years direct people management experience.  
• Bachelor’s Degree (general business, health sciences, public policy, or other related degrees) preferred 
• Licensed social worker or equivalent experience
• The Lead Case Manager must live within 45 minutes of a major airport and be able to travel extensively (overnight) 50% pf the time within all territories (East, Central, Mountain, Pacific)
• Schedule flexibility to be able to provide backup coverage for program operations and covering Case Manager responsibilities in the event of planned/unplanned absences and support needs in excess of capacity in a given territory between the operating hours of 9 am-5 pm

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS: 

• Exceptional listening, written and analytical skills. 
• Proficient in Word, Excel, and PowerPoint for presentation and report development.  
• Strong knowledge of customer care processes and techniques.  
• Excellent leadership, communication, and interpersonal skills.  
• Flexible, detailed, and able to successfully adapt to change.  
• Complies with all laws, regulations, and policies that govern CareMetx activities related to the contact center.  
• Proven track record of meeting or exceeding goals and objectives.  
• Work from home position, requires a dedicated office space that is quiet and free from distractions  
• Must be able to attend in person onboarding training for 3 days (i.e. product training etc.)

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  

• While performing the duties of this job, the employee is regularly required to sit.  
• The employee must occasionally lift and/or move up to 10 pounds.  

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule

• Schedule flexibility including alternating coverage between 9 am -9 pm EST  
• You must live within 45 minutes of a major airport I the designated territory (east, Central, Mountain or Pacific)  
• Must be able to attend in person onboarding training for 3 days (i.e. product training etc.)  
• Must be able to travel extensively (overnight) 50% of the time 

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.  

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.  

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin  

Requirements

Case Manager Lead must live within 45 minutes of a major airport and be able to travel extensively (overnight - 50% of the time) within all territories (East, Central, Mountain, Pacific).  

Schedule flexibility to be able to provide backup coverage for program operations and covering Case Manager responsibilities in the event of planned/unplanned absences and support needs in excess of capacity in a given territory (between the operating hours of 9am-9pm).