Care Specialist

Remote (United States)

Job Details

Location: United States

Workplace: Remote

Employment Type: Full-Time

Experience: Minimum of 7 years of progressive case management experience.

Core Areas: Patient access, case management, benefits investigations, prior authorizations, appeals, reimbursement, payer requirements, patient adherence support.

Compensation: Base salary of $110,000-$150,000 per year

Travel: Up to 10% as business needs require.

About the Role

The Care Specialist manages complex patient-access cases across an assigned geography, using independent judgment to assess needs, prioritize actions, and resolve barriers to therapy. Reporting to the Lead, Care Specialists within the Patient Services Team, this role determines support strategies and escalation pathways while contributing to first commercial launch readiness and ongoing program effectiveness.

The work centers on benefits investigations, prior authorizations, appeals, and reimbursement support for patients, caregivers, healthcare providers, partners, and insurance companies. It requires interpreting payer requirements and patient-services policies, handling non-routine cases, and translating reimbursement trends into practical recommendations. Patient adherence, sensitive information handling, and ethical, compliant decision-making are central to the position.

What You'll Do

• Independently evaluate patient and caregiver access needs and select appropriate support strategies to help patients obtain therapy promptly.
• Oversee and prioritize an assigned caseload, identify access barriers, determine next steps, and move cases through the required access processes.
• Interpret patient-services policies and payer requirements to guide complex benefits investigations, prior authorization and appeal support, and stakeholder communications.
• Maintain case documentation for the assigned geography and analyze case insights to identify reimbursement trends, access risks, and process improvement opportunities.
• Manage complex patient-access issues, assess reimbursement pathways, and determine resolution or escalation strategies within delegated authority.
• Act as an internal reimbursement subject matter expert, advising cross-functional partners on payer requirements, access barriers, and strategic case considerations.
• Provide ongoing patient adherence and compliance support in accordance with program requirements and approved processes.
• Share insights and recommendations during patient services and commercial strategy meetings, drawing on reimbursement trends, case escalations, and program performance.
• Lead special projects and recommend operational changes that improve patient-support program efficiency, compliance, scalability, and launch readiness.
• Model compliant practices across the commercial organization and broader organization by identifying compliance concerns and recommending improvements.
• Conduct all activities ethically and in accordance with applicable legal and regulatory requirements, including the U.S. Food, Drug, and Cosmetic Act, U.S. anti-kickback laws, and the PhRMA Code.

Qualifications

Required Experience

• At least 7 years of progressive case management experience, including evaluating complex patient-access matters, determining resolution pathways, and managing non-routine reimbursement issues.
• Demonstrated experience supporting patients, caregivers, and healthcare providers in a call center, customer service, or patient support environment requiring professional judgment, prioritization, and effective issue resolution.
• Advanced experience with pharmacy and medical benefit investigations, prior authorizations, appeals, reimbursement processes, and case escalations involving payer analysis and application of program guidelines.

Required Skills

• Strong knowledge of commercial and government payer requirements, coverage policies, and access pathways, with the ability to interpret and apply them to complex patient-access situations.
• Ability to identify reimbursement trends, assess access risks, recommend process improvements, and communicate strategic insights to internal stakeholders and management.
• Ability to work independently in a remote environment, exercise discretion with sensitive patient and reimbursement information, and manage priorities across an assigned geography.
• A patient-first mindset, collaborative influence, and adaptability in professional relationships.
• Strong analytical and problem-solving capabilities, supported by creative thinking.
• Ability to travel up to 10% as business needs require.

Preferred Qualifications

• Bachelor’s degree preferred; equivalent experience in rare disease patient support services, access and reimbursement, or related biotechnology or pharmaceutical roles involving independent decision-making may be considered.
• Rare disease experience strongly preferred.

Benefits

• Equity ownership opportunity.
• Workplace flexibility and flexible time off.
• Opportunity to help build and shape an early-stage commercial organization.
• A competitive benefits package.