National Director, Access Case Management

Key Responsibilities

• Lead and develop a high-performing national team of CMs.
• Manage team accountability, performance metrics, and engagement models.
• Establish clear KPIs for patient access, issue resolution time, documentation quality, and account satisfaction—ensuring all CMs to meet or exceed expectations.
• Drive a culture of urgency, ownership, and patient-centricity through coaching, virtual/remote people management, dashboard reviews, and performance management.
• Ensure Patient Access Advocates proactively manage and work individual patient cases to ensure access and financial barriers are compliantly overcome—including benefit verifications, PA delays, denials, appeals hurdles, specialty pharmacy and non-commercial pharmacy routing issues, affordability barriers, complex Center for Medicare and Medicaid cases (CMS), community resources and more.
• Build and oversee standardized escalation frameworks with the Field Reimbursement Team (FRDs), specialty pharmacies, non-commercial pharmacy and insurance providers to ensure rapid and compliant issue resolution.
• Maintain visibility into high-priority or at-risk cases, ensuring swift cross-functional engagement and timely resolution.
• Implement and manage data dashboards tracking patient access milestones (timing of contact with patient and providers during each milestone from enrollment to closure of case, benefit verification, PA status, appeals, specialty and noncommercial pharmacy dispense timing).
• Lead, partner with FRD Director, and set expectations for transitioning all EAP patients with urgency upon FDA approval.
• Monitor all patient cases for delays or bottlenecks, ensuring immediate contact with third party HUB and FRD team for follow-up of unresolved cases.
• Enforce rigorous documentation standards to ensure access barriers are tracked, addressed, and compliantly resolved in alignment with a "no patient left behind" mindset.
• Provide coaching, training, and ongoing development to Patient Access Advocates.
• Foster a culture grounded in compliance, customer centricity, urgency, and collaboration.
• Create and manage a "one-team" mindset with other critical access teams, including third-party hub provider, PAP pharmacy, third-party copay provider, FRD Team, and Patient Access leadership.

Launch Planning & Strategy

• Develop the national HUB CM launch strategy aligned with FRDs, distribution strategies, Market Access, and corporate strategies.
• Partner cross-functionally with FRDs, Patient Services, Trade/Distribution, and other teams as needed to ensure seamless patient initiation and continuity of therapy as prescribed.
• Design and refine Patient Access Advocate role scope, regional standards, KPIs, reporting structures, and rules of engagement.
• Identify and communicate regional challenges and insights to shape brand strategy, messaging, and resource planning.

Field Execution & Operations

• Oversees RMCMs engagement with patients, providers and FRDs to resolve access barriers (coverage, coding, billing, SP coordination, and appeals education).
• Ensure Patient Access Advocates provide non-promotional, compliant education on coverage, reimbursement, and financial assistance pathways.
• Establish clear field escalation workflows with HUB leadership, FRDs, non-commercial pharmacy, specialty pharmacy partners, and other internal stakeholders.
• Monitor Patient Access Advocates performance across regions and adjust tactics based on real-time insights and evolving market dynamics.

Cross-Functional Collaboration

• Partner closely with the Patient Services team to ensure service design, SLAs, and escalation paths support the oral oncology launch.
• Collaborate with PAP, copay, and distribution partners to ensure Patient Access Advocates understand and appropriately communicate program offerings.
• Work with Patient Services and FRDs to uncover national dynamics impacting access.
• Serve as the key HUB and RNCMs voice across Patient Services, brand leadership, Market Access, and cross-functional launch teams.

Compliance & Governance

• Ensure all Patient Access Advocates activities align with legal, regulatory, and compliance standards for oncology nurse case manager roles.
• Maintain and enforce rules of engagement, documentation standards, and coordination with the HUB team as it relates to the HUB Business Rules.
• Lead training on compliant communication related to access, reimbursement, affordability, and patient support services.

Insights, Reporting & Performance Management

• Analyze Patient Access Advocates insights to identify systemic barriers, payer trends, and opportunities to accelerate patient access.
• Partner with analytics and Patient Services teams to develop dashboards and performance reporting.
• Track and report KPIs, including access resolution times, appeal outcomes, account satisfaction, and RNCM productivity.
• Present field insight summaries and strategic recommendations to senior leadership.