Dedicated Case Coordinator

Dedicated Case Coordinator

Why Patients Need You

The Inflammation and Immunology Dedicated Case Coordinator (DCC) is a non-promotional, field-based role that supports patients’ access to PDPA and VFM products cuando prescribed by a licensed healthcare provider. The DCC owns the continual management and progression of the patient journey — from HUB enrollment through post-fill follow-up — working directly with patients, providers, payers, HUB partners, and third-party vendors. It is a dual patient- and HCP-facing role spanning a patient journey, and the colleague in this role carries 100% ownership of every case in their assigned geography.

What You Will Achieve

The DCC is a subject-matter expert on reimbursement, access, and coverage issues that can educate patients/caregivers and healthcare providers on matters relating to reimbursement, access, and coverage. The DCC will serve as the primary point of contact for patients/caregivers and healthcare providers regarding the status of their request for reimbursement support and access assistance and will also provide updates to patients/caregivers and healthcare providers on their status as appropriate. The DCC holds end-to-end case ownership: benefits investigation and verification, prior authorization and appeals support, appointment and baseline assessment coordination, Interim Care and voucher administration, copay support, prescription triage, and scheduled post-fill follow-up.

How You Will Achieve It

Case Ownership and the Patient Journey

• Own 100% of assigned cases and drive the continual management and progression of the patient journey, from HUB enrollment through post-fill follow-up

• Be the central point-of-contact for patients/caregivers and HCP providers regarding the status of their request for reimbursement and access support related to a patient case.

• Answer questions from patients/caregivers relating to access and coverage

• Maintain a clear understanding of the patient access journey and requirements at each stage of the process, as well as the role played by patients/caregivers and HCP providers in the process

• Support access with HCPs and opted-in patients/caregivers who have been prescribed a PDPA OR VFM product

Benefits Investigation and Financial Navigation

• Conduct the Summary of Benefits (SOB) discussion required for every HUB-enrolled patient, reviewing both the product benefit structure, any associated cost and the baseline appointments for VFM

• Obtain all missing information on the Patient Enrollment Form (PEF) and verify the testing, voucher, and Interim Care options selected by the HCP office

• Walk the patient through out-of-pocket cost, deductibles, copay options, and the reimbursement program, including the impact of maximizers and accumulators

• Verify coverage for the product and for required baseline tests across both PBM and major medical insurance for VFM

• Oversee the entire prior authorization process, including submission and verification with both the patient and the provider

• Conduct benefit investigation and verification (BI/BV) calls directly with payers and patients for patients with 3rd party restrictions

• Confirm and communicate product coverage, cost, prior authorization and appeal requirements, Interim Care program PA and Appeal deadlines, and baseline assessment tests to HCP and patient

Appointment and Assessment Coordination

• Schedule, reschedule and confirm patient appointments in coordination with the patient, the provider, and the vendor

• Secure the appropriate confirmation communication back from the provider (CFT)

• Coordinate compliantly with IQVIA/MDX on patient assessment tests — confirm tests are completed and reschedule where needed

Program and Copay Administration

• Once IC is approved, manage all Interim Care (IC) program administrative requirements and deadlines with the provider and the patient, including Extended Interim Care programs

• Confirm voucher need and eligibility with the provider and patient, and triage the voucher for shipment to the patient

• Maintain Copay portal access and help approved commercial patients secure a copay card

• Own copay eligibility attestation responsibility

• Follow up with the patient post-fill to confirm the copay card is functioning correctly

Prescription Triage, Fulfillment, and Ongoing Follow-Up

• Triage the voucher, paid prescription, and/or Interim Care fill within Polaris

• Contact the patient at 10 days and again at 45 days post-prescription, confirming that no logistical or financial questions remain outstanding

Case and Systems Ownership

• Manage and update various case types in Polaris, using its texting, faxing, and prescription triage capabilities

• View and interpret prior authorization, appeal, and PEF documentation for accuracy

• Share and manage cases with HUB partners across all patient journeys

• Coordinate as appropriate with other Pfizer colleagues and Patient Support Program/HUB employees, via tasks and secure messages to requests for action, to help resolve problems with individual patient cases

• Maintain case comments as a real-time account of the patient journey, including a recap of every call made to the HCP and the patient

• Use the Kite works encrypted email system for correspondence with patients and providers

• Manage the Docusign process with patients to obtain required consents

• Develop an organized, concise, and compliant way to manage assigned patient cases within established time frames

Compliance, Safety Reporting, and Communication

• Report adverse events (AEs) in accordance with company requirements — AE reporting volume is elevated in this role, patient contact is more frequent and spans the entire patient journey

• Operate within the tighter content controls and system permissions that apply to this role

• Compliantly communicate the access landscape and options to patients/caregivers and HCPs

• Link the patient access support to meet patient needs, using Brand RC-approved materials

• Conduct yourself with the utmost discretion and confidentiality

• Adhere to strict company compliance guidelines and procedures

• Work and lead cross-functionally with internal and external colleagues, compliantly, to improve the patient access journey

• Effectively link customer insights to the offerings and approved resources to address patient access barriers

• Build trust through compliant follow-up and knowledge of the access journey

• Demonstrate excellence in responsible business communication, both written and spoken