RareMed Solutions

Manager

• Serve as primary point of contact and case manager for client and customer inquiries and escalations
• Process benefits investigations, benefits verifications, prior authorization submissions, and appeals as necessary to accelerate patient care access
• Coordinates services with internal program operations and Program Management
• Manage patient claims for prescription drug and medical benefits in relation to providing excellent specialty pharmacy care
• Establish self as regional expert on payer trends, product access, and reporting reimbursement trends and/or delays
• Work independently to complete assigned working accordance with Standard Operating Procedures and defined service levels
• Use high-level problem-solving skills to research cases independently
• Maintain frequent phone contact with internal operational staff, external client, and external specialty pharmacies
• Provide exceptional, white glove, customer service to internal and external customers
• Provide support to ensure efficient referral processing from referral intake to triaging of prescription
• Independently and effectively resolve complex issues related to pharmacy reimbursement and patient support

Reimbursement Case Manager

• Serve as the point of contact for regionally aligned field team related to cases where Reimbursement Services are requested from Facility.
• Coordinate all BI related support and access services across all functions including patient support, benefits verification and triage to specialty pharmacy.
• Review and add Provider and Facility profile data to capture the key information related to HCP facilities and customers.
• Maintain frequent touchpoints through outreach to providers and patients/caregivers to communicate progress throughout their journey.
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete Service requests, program enrollment, answer inquiries, coordinate investigation and determination of patient benefits coordinate access to free Supply Program, if applicable.
• Independently and effectively identify adverse events and/or product complaints and triage as appropriate.
• Apply defined business rules to qualify patients for manufacturer supported programs.
• Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls.
• Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance.
• Refer patients to third-party or other foundation programs per program business rules.
• Manage case triage to Specialty Pharmacy or Long-Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison.
• Collaborate with SPs and field teams on case recovery efforts.
• Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility.
• Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules.
• Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately.
• Maintain frequent phone/email contact with internal operational staff, external client, external specialty pharmacies, providers, and payers. Utilizes outbound faxes, email alerts, and mailings per program guidelines.
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
• Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity.
• Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed.
• Provide support, education, and status updates to regionally aligned field teams, LTC facility staff, HCP offices, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups.
• Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
• Ability to coordinate and collaborate with manufacturer representatives, LTC facilities, HCP offices, and other key personnel on complex cases which require strategic intervention.

Benefit Investigation Case Manager

• Primary point of contact and case manager for client and customer inquiries and escalations
• Coordinates services with internal program operations and Program Management
• Manages assigned territory using problem solving skills and professional judgment to independently make sound decisions for timely case resolution
• Provides exceptional, white glove, customer service to internal and external customers
• Provides support to Patient Access Liaisons, HCP offices and patients to ensure efficient referral processing, triaging, and shipment set ups
• Processes PAP requests in a timely fashion as well as PAP re-approval verification for continued eligibility
• Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases

Regional Case Manager

SDET

• Define and own the test automation strategy across UI, API, integration, and regression testing.
• Design, implement, and maintain scalable automation frameworks aligned with product architecture.
• Evaluate and select automation tools, libraries, and testing approaches.
• Develop and maintain automated tests for Web applications (e.g., Angular/React), APIs and microservices, Backend and data validation scenarios.
• Lead and mentor QA Automation Engineers and Manual QA Engineers.
• Integrate automated testing into CI/CD pipelines (e.g., Bitbucket, GitHub, Azure DevOps).
• Collaborate with Product, Engineering, and Architecture teams to define acceptance criteria and testability requirements.
• Define and track QA metrics (test coverage, pass rates, defect trends, automation ROI).

QA Automation Lead

• Serve as the point of contact for regionally aligned field team related to cases identified as LTC to initiate and support therapy to residents of long-term care facilities.
• Coordinate all LTC facility-related support and access services across all functions but not limited to: support on patient journey calls, benefits verification, prior authorization and appeals, triage to specialty pharmacy or Long-Term Care Pharmacies, and any necessary follow ups.
• Maintain clear, concise, and accurate documentation on all accounts according to Standard Operating Procedures.
• Review and add LTC profile data to capture the key information related to LTC facilities and customers.
• Conduct initial welcome calls to LTC facility-designated champions and/or patients/caregivers informing them of available services as well as future targeted outreach to provide ongoing support.
• Maintain frequent touchpoints through outreach to LTC providers and patients/caregivers to communicate progress throughout their journey.
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to free 14-Day Supply Program, if applicable.
• Independently and effectively identify adverse events and/or product complaints to document and triage as appropriate.
• Apply defined business rules to qualify patients for manufacturer supported programs.
• Interact and coordinate with internal program operations, including reimbursement, and program management to ensure provider and patient needs are met in addition to attending any regularly scheduled calls.
• Provide support, education and status updates to regionally aligned field teams, LTC facility staff, patients and caregivers to ensure efficient referral processing, triaging, and shipment set ups.
• Manage assigned territory using problem solving skills and professional judgement to independently make sound decisions for timely case resolution.
• Ability to coordinate and collaborate with manufacturer representatives, LTC facilities and other key personnel on complex cases which require strategic intervention.
• Independently and effectively resolves complex issues with creativity and innovation while maintaining compliance.
• Refer patients to third-party or other foundation programs per program business rules.
• Manage case triage to Specialty Pharmacy or Long Term Care Pharmacy, if applicable, and ensure proper information has been communicated to the Specialty Pharmacy Liaison.
• Collaborate with Long Term Care Pharmacies and field teams on account progression and case recovery efforts and provide relevant case status details and updates.
• Process PAP requests, when applicable per program business rules, in a timely fashion and PAP re-approval verification for continued eligibility.
• Demonstrate the ability to prioritize and balance the needs of patients, LTC facility staff and rare disease clients utilizing program business rules.
• Provide concierge-level service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; escalate appropriately.
• Maintain frequent phone/email contact with internal operational staff, external client, external specialty pharmacies, providers and payers.
• Utilizes outbound faxes, email alerts, and mailings per program guidelines.
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
• Actively participate in building and maintaining respectful, collaborative team relationships, exercising, and encouraging positivity.
• Other duties as assigned including cross training to support all Regional Patient Case Manager activities when needed.

Reimbursement Case Manager

Benefit Investigation Case Manager

Regional Case Manager

QA Automation Lead

Regional Patient Case Manager – Long Term Care