Dedicated Case Coordinator Carolinas

Job description

Why Patients Need You The Inflammation and Immunology Dedicated Case Coordinator (DCC) is a non-promotional, field-based role that supports patients’ access to PDPA and VFM products when prescribed by a licensed healthcare provider. The DCC owns the continual management and progression of the patient journey — from HUB enrollment through post-fill follow-up — working directly with patients, providers, payers, HUB partners, and third-party vendors. It is a dual patient- and HCP-facing role spanning a patient journey, and the colleague in this role carries 100% ownership of every case in their assigned geography. What You Will Achieve The DCC is a subject-matter expert on reimbursement, access, and coverage issues that can educate patients/caregivers and healthcare providers on matters relating to reimbursement, access, and coverage. The DCC will serve as the primary point of contact for patients/caregivers and healthcare providers regarding the status of their request for reimbursement support and access assistance and will also provide updates to patients/caregivers and healthcare providers on their status as appropriate. The DCC holds end-to-end case ownership: benefits investigation and verification, prior authorization and appeals support, appointment and baseline assessment coordination, Interim Care and voucher administration, copay support, prescription triage, and scheduled post-fill follow-up. How You Will Achieve It Case Ownership and the Patient Journey Own 100% of assigned cases and drive the continual management and progression of the patient journey, from HUB enrollment through post-fill follow-up Be the central point-of-contact for patients/caregivers and HCP providers regarding the status of their request for reimbursement and access support related to a patient case. Answer questions from patients/caregivers relating to access and coverage Maintain a clear understanding of the patient access journey and requirements at each stage of the process, as well as the role played by patients/caregivers and HCP providers in the process Support access with HCPs and opted-in patients/caregivers who have been prescribed a PDPA OR VFM product Benefits Investigation and Financial Navigation Conduct the Summary of Benefits (SOB) discussion required for every HUB-enrolled patient, reviewing both the product benefit structure, any associated cost and the baseline appointments for VFM Obtain all missing information on the Patient Enrollment Form (PEF) and verify the testing, voucher, and Interim Care options selected by the HCP office Walk the patient through out-of-pocket cost, deductibles, copay options, and the reimbursement program, including the impact of maximizers and accumulators Verify coverage for the product and for required baseline tests across both PBM and major medical insurance for VFM Oversee the entire prior authorization process, including submission and verification with both the patient and the provider Conduct benefit investigation and verification (BI/BV) calls directly with payers and patients for patients with 3rd party restrictions Confirm and communicate product coverage, cost, prior authorization and appeal requirements, Interim Care program PA and Appeal deadlines, and baseline assessment tests to HCP and patient Appointment and Assessment Coordination Schedule, reschedule and confirm patient appointments in coordination with the patient, the provider, and the vendor Secure the appropriate confirmation communication back from the provider (CFT) Coordinate compliantly with IQVIA/MDX on patient assessment tests — confirm tests are completed and reschedule where needed Program and Copay Administration Once IC is approved, manage all Interim Care (IC) program administrative requirements and deadlines with the provider and the patient, including Extended Interim Care programs Confirm voucher need and eligibility with the provider and patient, and triage the voucher for shipment to the patient Maintain Copay portal access and help approved commercial patients secure a copay card Own copay eligibility attestation responsibility Follow up with the patient post-fill to confirm the copay card is functioning correctly Prescription Triage, Fulfillment, and Ongoing Follow-Up Triage the voucher, paid prescription, and/or Interim Care fill within Polaris Contact the patient at 10 days and again at 45 days post-prescription, confirming that no logistical or financial questions remain outstanding Case and Systems Ownership Manage and update various case types in Polaris, using its texting, faxing, and prescription triage capabilities View and interpret prior authorization, appeal, and PEF documentation for accuracy Share and manage cases with HUB partners across all patient journeys Coordinate as appropriate with other Pfizer colleagues and Patient Support Program/HUB employees, via tasks and secure messages to requests for action, to help resolve problems with individual patient cases Maintain case comments as a real-time account of the patient journey, including a recap of every call made to the HCP and the patient Use the Kite works encrypted email system for correspondence with patients and providers Manage the Docusign process with patients to obtain required consents Develop an organized, concise, and compliant way to manage assigned patient cases within established time frames Compliance, Safety Reporting, and Communication Report adverse events (AEs) in accordance with company requirements — AE reporting volume is elevated in this role, patient contact is more frequent and spans the entire patient journey Operate within the tighter content controls and system permissions that apply to this role Compliantly communicate the access landscape and options to patients/caregivers and HCPs Link the patient access support to meet patient needs, using Brand RC-approved materials Conduct yourself with the utmost discretion and confidentiality Adhere to strict company compliance guidelines and procedures Work and lead cross-functionally with internal and external colleagues, compliantly, to improve the patient access journey Effectively link customer insights to the offerings and approved resources to address patient access barriers Build trust through compliant follow-up and knowledge of the access journey Demonstrate excellence in responsible business communication, both written and spoken Qualifications Must-Have B.S. or B.A. Degree 8+ years of pharmaceutical (or related) experience in customer-facing roles/functions. 6 months minimum as a FRM, PAC, FAS or similar experience in access and Reimbursement and working with Polaris CRM System. Working proficiency in Polaris, including case management and documentation, prescription triage, and interpretation of PA, appeal, and PEF documentation Demonstrated ability to communicate directly with patients, with providers, and with cross-functional colleagues Experience conducting benefit investigation and verification directly with payers, and working knowledge of prior authorization and appeals processes Working knowledge of copay programs, copay maximizers and accumulators, vouchers, and free or interim care programs Ability to own a high volume of concurrent cases across a patient journey that could average approximately 20 days, with disciplined documentation and follow-through Ability to meet adverse event reporting obligations in a role with frequent, direct patient contact Strong understanding of Reimbursement, Government Payment Systems, Specialty Pharmacy Networks, Co-Pay Assistance Programs, and knowledge of the Specialty Medication area. Appropriate and compliant communication and collaboration with cross-functional field-based colleagues (Sales, Medical, FRM, PCA/SAS, KAD, Government Relations) to ensure optimal and appropriate patient access in both in-patient and out-patient accounts. Alignment with HQ stakeholders to ensure appro