Sanofi Group Case Management Specialist Sr in Cambridge, Massachusetts
Exhibit a high level of case management expertise and demonstrated leadership skills. Utilize care coordination to address patient concerns; obtain insurance approval for enzyme replacement therapy and proactively plan for the maintenance of coverage by working with the patient, family, insurance company, physicians, workplace benefits administrators and persons from other areas of Sanofi Genzyme. Facilitate the case management process along the healthcare continuum.
Manages the Care Coordination process while balancing the needs of individual patients with the business realities and necessities of Sanofi Genzyme and US Rare Disease.
Assesses patients’ needs and develops action plans that provide for the introduction and continuation of enzyme replacement therapy while coordinating the exchange of all patient-related information with internal and external customers
Maintains comprehensive understanding of the reimbursement process, billing/coding nuances, dose calculations, insurance plans, payer trends, financial assistance programs, charitable access, and related resources
Assists in obtaining insurance approval for enzyme replacement therapy, and proactively plans for maintenance of coverage by working with the patients and their family, healthcare providers, insurance companies, specialty pharmacies, and Sanofi Genzyme Colleagues.
Maintains up-to-date knowledge of the resources available at the regional level, including alternative resources, and applies this knowledge in way that best supports patient care
Educates patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate and maintain enzyme replacement therapy, case management services and relevant disease/product information as necessary.
Exhibits a leadership role within the optimization team. Able to consistently identify complex patient specific issues and develop action plans accordingly. Demonstrates accountability for action plan execution, and energetically drives for success and results
Establishes and maintains professional and effective relationships with all internal and external customers including but not limited to care coordination colleagues, medical, sales, corporate accounts, Patient Advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators.
Attends patient meetings, site visits, conferences and trade shows to educate individuals regarding case management services. Represent Sanofi Genzyme in all venues in a professional manner.
Raises own performance expectations and goals to support entrepreneurial approach to the business
Demonstrates understanding of Sanofi Genzyme’s business model, and their role in commercializing the business
Consistently monitors systems and processes and recognizes when it is time to try new approaches
Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested.
Consistently maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions. Coordination of information with all customers is required.
Is proficient in the use of Salesforce and in producing data specific reports upon request
Bachelor’s Degree in Health Care/Social Work/Nursing (or equivalent).
Four to six years recent experience in the case management process.
Experience should include but is not limited to home care management, case management review, utilization review, social service support, insurance reimbursement and patient advocacy.
Industry experience preferred. In-depth understanding of health insurance benefits, relevant state and federal laws and insurance regulations.
Developed communication, mediation, and problem solving skills.
Experience with data entry/computer literate skills.
Ability to identify and handle sensitive issues with opposing opinions, work independently and handle projects or multiple tasks.
Ability to travel required, up to 25%, possibly weekends.
Spanish speaking skills a plus.
Sanofi Inc. and its U.S. affiliates are Equal Opportunity and Affirmative Action employers committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race; color; creed; religion; national origin; age; ancestry; nationality; marital, domestic partnership or civil union status; sex, gender, gender identity or expression; affectional or sexual orientation; disability; veteran or military status or liability for military status; domestic violence victim status; atypical cellular or blood trait; genetic information (including the refusal to submit to genetic testing) or any other characteristic protected by law.
At Sanofi diversity and inclusion is foundational to how we operate and embedded in our Core Values. We recognize to truly tap into the richness diversity brings we must lead with inclusion and have a workplace where those differences can thrive and be leveraged to empower the lives of our colleagues, patients and customers. We respect and celebrate the diversity of our people, their backgrounds and experiences and provide equal opportunity for all.
Sanofi is dedicated to supporting people through their health challenges. We are a global biopharmaceutical company focused on human health. We prevent illness with vaccines, provide innovative treatments to fight pain and ease suffering. We stand by the few who suffer from rare diseases and the millions with long-term chronic conditions.
With more than 100,000 people in 100 countries, Sanofi is transforming scientific innovation into healthcare solutions around the globe.
Sanofi, Empowering Life