Role Description
The Nurse Case Manager (NCM) is a licensed Registered Nurse and senior individual contributor responsible for providing high-touch, non-promotional clinical education, care coordination, and access support to patients, caregivers, and healthcare providers throughout therapy initiation and ongoing management. This role supports a rare disease population and sits at the intersection of Patient Support and Access, Market Access, and Clinical Operations. The NCM role is designed for an experienced nurse with deep expertise in specialty pharmacy workflows, reimbursement processes, and complex patient journey coordination.
Duties/Responsibilities
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Patient and Caregiver Support
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Serve as a primary point of contact for patients and caregivers, providing non-promotional education, care coordination, and ongoing support across the treatment journey.
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Educate patients and caregivers on therapy initiation processes, administration considerations, one-time treatment expectations, and program resources within approved scope.
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Provide high-touch, empathetic support tailored to the needs of patients living with a rare, chronic condition.
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Identify treatment journey risks, care gaps, or psychosocial barriers and proactively coordinate appropriate support or escalation.
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Provide education and support within approved program boundaries and does not replace or supersede the treating healthcare provider.
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Access, Reimbursement, and Coverage Coordination
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Guide and coordinate benefits verification, prior authorization, and appeals activities in collaboration with internal access teams, specialty pharmacies, and external partners.
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Support the PAL team working with healthcare providers and office staff by clarifying coverage pathways, documentation requirements, and next steps for access resolution.
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Proactively identify access barriers, delays, or payer-related challenges and collaborate cross-functionally to drive timely resolution.
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Care Coordination and Therapy Initiation
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Coordinate with specialty pharmacies, infusion centers, and internal teams to support timely therapy initiation and coordination of care.
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Track case progression from enrollment through therapy initiation and long-term follow-up requirements.
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Support transitions of care and ongoing coordination as patient needs evolve.
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Case Management, Documentation, and Insights
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Maintain accurate, timely, and compliant case documentation within CRM and case management systems.
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Manage assigned case load effectively while prioritizing high-risk or complex patient cases.
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Escalate complex cases according to established workflows and collaborate with cross-functional partners to resolve issues.
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Capture and communicate patient, caregiver, and provider insights to support continuous program improvement and operational optimization.
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Compliance and Regulatory Responsibilities
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Adhere to all company policies, standard operating procedures, and compliance requirements.
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Maintain strict patient privacy and confidentiality in accordance with HIPAA and applicable regulations.
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Fulfill all pharmacovigilance and adverse event reporting obligations in a timely and compliant manner.
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Operate within non-promotional guidelines and approved program scope at all times.
Qualifications
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Active, unrestricted U.S. Registered Nurse (RN) license
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Bachelorβs degree required; BSN preferred
Requirements
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Minimum 8 years of nursing experience in healthcare or biotech industry
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At least 5 years of case management experience, preferably in rare diseases or specialty therapeutics
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Experience with infusion therapies and specialty pharmacy coordination preferred
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Experience with rare disease or gene therapy drug launch preferred
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Demonstrated experience in patient education and on-label clinical communication
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Deep understanding of rare disease pathophysiology and treatment protocols
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Adherence to HIPAA, pharmacovigilance, and company policies
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Ability to manage case load and escalate appropriately
Benefits
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Base salary expected to range between $193,500.00 - $236,500.00 USD per year
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Performance-based annual cash bonus
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New hire equity grant
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Eligibility for annual equity awards
Working Conditions
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Field-based position with 20% travel required
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Flexibility to work evenings and weekends as needed to support patient needs
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Must be willing to attend industry conferences and patient advocacy events