RareMed Solutions
Purpose: The Patient Navigator (PN) is a professional external-facing role responsible for proactive outreach and support, accurate and timely response to inquiries regarding specific referral status or escalation. The PN must develop a deep understanding of program deliverables and ensure program compliance with documented business rules. The PN educates on program service offerings and efficiently manages service delivery of assigned programs. Acting as the primary point of contact for professional, concise internal and external communication regarding case status updates, next steps in prescription processing, reimbursement support, etc., the PN interacts directly with patients, healthcare providers, and insurance payers as well as internal teams including Operations and Program Management to ensure cases move forward. The PN communicates updates on internal activities and collaborates with internal and clinical teams to support the patient journey. The PN assists in coordinating available reimbursement resources for patients to ensure efficient processing of referrals from initiation to delivery of prescribed product. The role requires sound judgment and the highest level of professional standards in all interactions with patients, HCP offices, program and specialty pharmacies, payers, and manufacturer clients. The PN will be directly involved with developing and enhancing program efficiencies and evaluating opportunities for improvement of the program experience for referred patients and HCP offices.
Responsibilities
Primary point of contact for the patient journey.
Coordinate services with internal program operations and Program Management.
Accurately assess, plan, implement, and evaluate patient/caller needs for guidance throughout the patient journey, including psychosocial support calls.
Possess a broad and deep understanding of oncology, products, and support programs.
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 therapies.
Process patient and prescriber requests to ensure timely access to therapy.
Utilize strategic intervention to collaborate efficiently and with urgency with key personnel to expedite processing of referrals from initiation to delivery of product.
Assist with challenges by demonstrating appropriate judgment skills to make independent solid decisions.
Respond to client inquiries within expected timeframes according to program requirements and leadership direction.
Collaborate with leadership to identify opportunities to improve program efficiency and patient care solutions.
Remain flexible and responsive when changes occur in patient activity, workload and scheduling.
Assume accountability for own professional practice in achieving optimal patient outcomes.
Use problem‑solving skills and professional judgment to independently make decisions.
Maintain frequent phone contact to resolve any inquiries or requests with internal operational staff, external clients and patients, and external specialty pharmacies.
Provide exceptional, white‑glove customer service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; and appropriately escalates.
Provide support to ensure efficient referral processing and triaging of prescriptions.
Support payer processes, product access, and navigate prior‑authorization processes to help patients gain access to product.
Understand payer trends, product access, and reporting reimbursement trends and/or delays (e.g., denials, underpayment, access delays, etc.).
Demonstrate a strong compliance mindset, with a clear understanding of patient privacy laws.
Participate actively in building and maintaining respectful, collaborative internal/external team relationships, exercising and encouraging positivity.
Other duties as assigned.
Required Qualifications
Bachelor’s Degree or 3–5 years of social work, case management or patient advocacy experience.
Must have oncology, hematology and/or rare disease experience.
Advanced knowledge and experience in a healthcare setting, with 2+ years in a pharmacy, healthcare setting, and/or insurance background.
Strong analytical and organizational skills with attention to detail.
Ability to independently manage case load, prioritize work, and use time‑management skills to meet deliverables.
Experience in social work, case management, or patient advocacy, including strong coaching skills.
Excellent verbal and written communication skills.
Empathy, drive, and commitment to exceptional service.
Strong reimbursement knowledge of BI/BV prescription benefits, PA authorizations, access management.
Proficient in Microsoft Excel, Outlook, and Word.
Preferred Qualifications
Pharmaceutical industry, reimbursement case management, and/or specialty pharmacy experience.
Ability to build productive internal/external working relationships.
Case Management and/or Patient Navigator experience.
Professional interpersonal skills with patients, HCPs and manufacturer clients.
Ability to coordinate and manage deliverables with a sense of urgency.
Meticulous attention to detail.
Ability to exercise independent judgment.
Ability to demonstrate empathy and handle stressful patient situations with realistic expectations while supporting a positive outlook.
Staying current in developments related to specific disease states.
Ability to learn and navigate the CRM platform with ease.
Ability to learn new processes quickly.
Work Environment RareMed offers a hybrid work structure, combining remote work and in‑office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and be able to report to the office when needed. Employees are responsible for the setup of their home office environment, including reliable internet access, phone line, electricity, lighting, comfortable temperature, furniture, etc. The employee’s teleworking space should be separate and distinct from their home space and allow for privacy.
Physical Demands While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, use hands and fingers, handle or feel, and reach with hands and arms.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
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Responsibilities
Primary point of contact for the patient journey.
Coordinate services with internal program operations and Program Management.
Accurately assess, plan, implement, and evaluate patient/caller needs for guidance throughout the patient journey, including psychosocial support calls.
Possess a broad and deep understanding of oncology, products, and support programs.
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 therapies.
Process patient and prescriber requests to ensure timely access to therapy.
Utilize strategic intervention to collaborate efficiently and with urgency with key personnel to expedite processing of referrals from initiation to delivery of product.
Assist with challenges by demonstrating appropriate judgment skills to make independent solid decisions.
Respond to client inquiries within expected timeframes according to program requirements and leadership direction.
Collaborate with leadership to identify opportunities to improve program efficiency and patient care solutions.
Remain flexible and responsive when changes occur in patient activity, workload and scheduling.
Assume accountability for own professional practice in achieving optimal patient outcomes.
Use problem‑solving skills and professional judgment to independently make decisions.
Maintain frequent phone contact to resolve any inquiries or requests with internal operational staff, external clients and patients, and external specialty pharmacies.
Provide exceptional, white‑glove customer service to internal and external customers; resolve any customer and client requests in a timely and accurate manner; and appropriately escalates.
Provide support to ensure efficient referral processing and triaging of prescriptions.
Support payer processes, product access, and navigate prior‑authorization processes to help patients gain access to product.
Understand payer trends, product access, and reporting reimbursement trends and/or delays (e.g., denials, underpayment, access delays, etc.).
Demonstrate a strong compliance mindset, with a clear understanding of patient privacy laws.
Participate actively in building and maintaining respectful, collaborative internal/external team relationships, exercising and encouraging positivity.
Other duties as assigned.
Required Qualifications
Bachelor’s Degree or 3–5 years of social work, case management or patient advocacy experience.
Must have oncology, hematology and/or rare disease experience.
Advanced knowledge and experience in a healthcare setting, with 2+ years in a pharmacy, healthcare setting, and/or insurance background.
Strong analytical and organizational skills with attention to detail.
Ability to independently manage case load, prioritize work, and use time‑management skills to meet deliverables.
Experience in social work, case management, or patient advocacy, including strong coaching skills.
Excellent verbal and written communication skills.
Empathy, drive, and commitment to exceptional service.
Strong reimbursement knowledge of BI/BV prescription benefits, PA authorizations, access management.
Proficient in Microsoft Excel, Outlook, and Word.
Preferred Qualifications
Pharmaceutical industry, reimbursement case management, and/or specialty pharmacy experience.
Ability to build productive internal/external working relationships.
Case Management and/or Patient Navigator experience.
Professional interpersonal skills with patients, HCPs and manufacturer clients.
Ability to coordinate and manage deliverables with a sense of urgency.
Meticulous attention to detail.
Ability to exercise independent judgment.
Ability to demonstrate empathy and handle stressful patient situations with realistic expectations while supporting a positive outlook.
Staying current in developments related to specific disease states.
Ability to learn and navigate the CRM platform with ease.
Ability to learn new processes quickly.
Work Environment RareMed offers a hybrid work structure, combining remote work and in‑office requirements. The frequency of onsite requirements will vary depending on role, operational needs, meetings, client visits, or team collaboration activities. Employees must be within commuting distance to Pittsburgh, PA, and be able to report to the office when needed. Employees are responsible for the setup of their home office environment, including reliable internet access, phone line, electricity, lighting, comfortable temperature, furniture, etc. The employee’s teleworking space should be separate and distinct from their home space and allow for privacy.
Physical Demands While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, use hands and fingers, handle or feel, and reach with hands and arms.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
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