Lead Patient Navigator Social Worker

Under the general direction of Operations Management, the Lead Patient Navigator Social Worker manages, coaches, develops, directs, and leads a high-performing team of field-based Case Managers. This role educates patients and their families on product access, reimbursement processes, and therapy delivery management. Additionally, the role supports patients, caregivers, and providers to ensure access to therapy and ongoing compliance.

Responsibilities

• Lead the execution of patient access-related strategies and objectives for all assigned therapies.
• Collaborate with other program leaders to develop new strategies supporting the launch of new therapies or advancing patient access for existing therapies.
• Work with and through Case Managers to ensure regional patient access performance meets or exceeds company objectives.
• Educate field-based teams on patient access issues.
• Implement Management by Objectives (MBOs) for each Case Manager to ensure team objectives are achieved.
• Coach, develop, motivate, and monitor team performance, including providing regular feedback, actionable development plans, and addressing performance gaps.
• Work closely with patients, caregivers, and providers to facilitate access to therapy.
• Collaborate with Specialty Pharmacy and Hub to obtain reimbursement coverage.
• Provide information to patients and caregivers on reimbursement and financial assistance options.
• Manage transition to home therapy, coordinating with specialty infusion pharmacies and nursing agencies for reimbursement and supplies.
• Maintain case history for all assigned patients in the CRM system.
• Resolve ongoing reimbursement issues (e.g., insurance changes, prior authorizations).
• Work with Field Sales Reps and the Market Access team.
• Answer patient and medical office inquiries, resolving access and reimbursement-related problems.
• Provide ongoing support through regular calls and potential in-person meetings with patients and families.
• Manage patient assistance requests and process applications with partners.
• Provide backup coverage for program operations and Case Manager responsibilities during absences or capacity needs.

Requirements

• Minimum 10+ years of experience in the pharmaceutical/healthcare industry.
• Minimum 3+ years of reimbursement management experience.
• Minimum 3+ years of direct people management experience.
• Bachelor’s Degree (general business, health sciences, public policy, or related fields) preferred.
• Licensed social worker or equivalent experience.
• Must live within 45 minutes of a major airport and be able to travel extensively (overnight) 50% of the time within all territories (East, Central, Mountain, Pacific).
• Schedule flexibility to provide backup coverage between 9 AM–5 PM, including potential extended hours (9 AM–9 PM EST).

Skills

• Exceptional listening, written, and analytical skills.
• Proficient in Word, Excel, and PowerPoint for presentation and report development.
• Strong knowledge of customer care processes and techniques.
• Excellent leadership, communication, and interpersonal skills.
• Flexible, detail-oriented, and adaptable to change.
• Compliance with all laws, regulations, and policies governing CareMetx activities.
• Proven track record of meeting or exceeding goals and objectives.
• Work-from-home position requiring a dedicated, quiet, and distraction-free office space.
• Must attend in-person onboarding training for 3 days (e.g., product training).

Schedule

• Schedule flexibility, including alternating coverage between 9 AM–9 PM EST.
• Must live within 45 minutes of a major airport in the designated territory (East, Central, Mountain, or Pacific).
• Extensive travel required, including one to two field visits or supervisions per month.

Physical Demands

• Regularly required to sit.
• Must occasionally lift and/or move up to 10 pounds.
• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Work Environment

• Moderate noise level in the work environment.
• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.