Patient Nurse Navigator - Specialty Pharmacy

About the role

Welcome new patients and caregivers, create patient profiles, and maintain ongoing system documentation of communications.
Interpret, assess, and conduct educational support for patients, caregivers, and treatment teams.
Communicate with prescribers and their agents and the client.
Conduct insurance verification and follow up for patient coverage and explain benefits to patients, initial and ongoing.
Process wholesale distribution of specialty product to an authorized facility and follow up on invoices.
Obtain and maintain prior authorizations and appeals documentation.
Relay financial and travel assistance information to patients and compliantly execute services.
Obtain all necessary consent forms.
Cook up and schedule patient and caregiver logistics, including transportation and lodging.
Manage, secure, and utilize travel and logistics platforms and complete expense tracking and reimbursement.
Ability to travel for multiple days and connect for remote work as needed.
Dually coordinate field travel to provide in-person support to patients receiving treatment.
Be the first point of contact for patients and maintain continuity of care through in-person contact, if requested, via travel to specified treatment center cities.
Regularly follow up with patients to assess and gather treatment and journey-related information.
Aid in preparing any ad hoc report requests from clients.
Perform case management services.
Serve as a mentor for new team members.
Collect and report adverse events reported by patients as outlined in SOPs.
Monitor external websites relating to therapy areas.
Serve as a liaison between patients, providers, and payers.

Key Responsibilities

• Welcome new patients and caregivers, create patient profiles, and maintain ongoing system documentation of communications.
• Interpret, assess, and conduct educational support for patients, caregivers, and treatment teams.
• Communicate with prescribers and their agents and the client.
• Conduct insurance verification and follow up for patient coverage and explain benefits to patients, initial and ongoing.
• Process wholesale distribution of specialty product to an authorized facility and follow up on invoices.
• Obtain and maintain prior authorizations and appeals documentation.
• Relay financial and travel assistance information to patients and compliantly execute services.
• Obtain all necessary consent forms.
• Cook up and schedule patient and caregiver logistics, including transportation and lodging.
• Manage, secure, and utilize travel and logistics platforms and complete expense tracking and reimbursement.
• Ability to travel for multiple days and connect for remote work as needed.
• Dually coordinate field travel to provide in-person support to patients receiving treatment.
• Be the first point of contact for patients and maintain continuity of care through in-person contact, if requested, via travel to specified treatment center cities.
• Regularly follow up with patients to assess and gather treatment and journey-related information.
• Aid in preparing any ad hoc report requests from clients.
• Perform case management services.
• Serve as a mentor for new team members.
• Collect and report adverse events reported by patients as outlined in SOPs.
• Monitor external websites relating to therapy areas.
• Serve as a liaison between patients, providers, and payers.

Skills, Education & Abilities

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or government regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Experience with utilizing and developing patient assessments and questionnaires.
• Ability to assess and advise patients via conversation.
• Knowledge to effectively present information and respond to questions from groups of managers, patients, nurses, and physicians.
• Experience with prior authorization, appeals, and SMN preparation.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Relentless attention to detail, and the ability to be a creative self-starter and team player.
• The ability to work independently.
• The ability to function in a leadership capacity.
• Excellent oral and written communication skills.
• Excellent organizational plus interpersonal skills.
• Knowledge of the insurance process, Medicare, and Medicaid billing.
• Knowledge of medical/pharmacy terminology and insurance benefit language; ie. EOB’s, deductibles, out-of-pocket, co-insurance, co-pays, etc.
• Ability to define CMS 1500’s, provider numbers, CPT, HCPCs, ICD9, NCPDP, and NDC codes/numbers.
• Patient Assistance Program knowledge.
• The ability to motivate a team to produce quality materials within tight timeframes and simultaneously manage several projects.
• The ability to participate in and facilitate group meetings.
• Willingness to work a flexible schedule, navigate large cities, and travel via air and ground transportation as needed.
• The ability to manage on-call services on a rotating schedule.
• Reasonable knowledge of technology and information systems, and software applications such as text documents, slide presentations, spreadsheets.

Essential Requirements

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or government regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Experience with utilizing and developing patient assessments and questionnaires.
• Ability to assess and advise patients via conversation.
• Knowledge to effectively present information and respond to questions from groups of managers, patients, nurses, and physicians.
• Experience with prior authorization, appeals, and SMN preparation.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Relentless attention to detail, and the ability to be a creative self-starter and team player.
• The ability to work independently.
• The ability to function in a leadership capacity.
• Excellent oral and written communication skills.
• Excellent organizational plus interpersonal skills.
• Knowledge of the insurance process, Medicare, and Medicaid billing.
• Knowledge of medical/pharmacy terminology and insurance benefit language; ie. EOB’s, deductibles, out-of-pocket, co-insurance, co-pays, etc.
• Ability to define CMS 1500’s, provider numbers, CPT, HCPCs, ICD9, NCPDP, and NDC codes/numbers.
• Patient Assistance Program knowledge.
• The ability to motivate a team to produce quality materials within tight timeframes and simultaneously manage several projects.
• The ability to participate in and facilitate group meetings.
• Willingness to work a flexible schedule, navigate large cities, and travel via air and ground transportation as needed.
• The ability to manage on-call services on a rotating schedule.
• Reasonable knowledge of technology and information systems, and software applications such as text documents, slide presentations, spreadsheets.

Preferred Qualifications

• Experience in a specialty pharmacy is a plus.
• Experience with cell and gene therapies.
• Direct patient experience with oral, subcutaneous, and/or IV medications preferred.
• Holds a compact nursing license and is willing to obtain other state licenses as requested by leadership.

About Us

AscellaHealth is a mission-driven, global healthcare company focused on solving challenges across the complex specialty and retail pharmaceutical ecosystem—always with patients at the center of what we do. We partner with payers, pharmaceutical manufacturers, and healthcare stakeholders to improve access to critical therapies through technology-enabled solutions that span the full pharmaceutical lifecycle, from commercialization and specialty pharmacy to care coordination, distribution, and pharmacy management. Supporting more than 450 health partners and 1.2 million patients worldwide, our work makes a meaningful difference every day.

What sets AscellaHealth apart

• We are a collaborative, entrepreneurial team that values transparency, continuous learning, and shared purpose.
• Employees are encouraged to bring ideas forward, take ownership of their work, and grow alongside a company recognized by Inc. and the Financial Times for sustained success.
• At AscellaHealth, you’ll find a supportive environment where your contributions matter and your work helps shape the future of specialty healthcare.

Learn More

Discover more about our mission, leadership team, and what makes us a great place to work by visiting https://ascellahealth.com/about-us.