Heather Jones
Northbridge,MA
Summary
Patient Services and Hub Operations leader with 8+ years of experience in pharmaceutical reimbursement and patient support programs, including team leadership, case management oversight, performance management, and client-facing operations. Proven track record of leading, coaching, and developing Case Managers, ensuring exceptional customer experiences for patients, providers, and manufacturer partners. Deep expertise in payer reimbursement (commercial, Medicare, Medicaid), CRM documentation, KPI/SLA management, SOP development, audits, and process optimization. Recognized for collaborative leadership, data-driven decision making, and passion for improving access to therapy in complex and rare disease environments.
Overview
9
9
years of professional experience
Work History
Director of Patient Support Services – Hub Operations
AllCare Plus Pharmacy, an IQVIA Business
Northborough, MA
01.2024 - Current
- Provide strategic and operational leadership for patient services hub operations supporting specialty pharmaceutical programs
- Lead, coach, and develop a team of 2 Program Managers and 16 Case Managers, ensuring consistent delivery of high-quality patient and provider support
- Direct day-to-day operations including caseload distribution, coverage planning, workflow optimization, and performance monitoring
- Identify regional and program-level trends, translating insights into short- and long-term operational strategies
- Ensure all patient, provider, payer, and service partner interactions are accurately documented in CRM, maintaining data integrity and audit readiness
- Develop, assign, and monitor performance goals tied to KPIs and SLAs, reporting outcomes to senior leadership
- Serve as a resource and escalation point for complex access, reimbursement, and customer service issues
- Lead Quarterly Business Reviews, presenting performance metrics, customer experience insights, risks, and optimization strategies to manufacturer partners
- Collaborate cross-functionally with executive leadership, compliance, quality, and client stakeholders to drive service excellence and regulatory adherence
- Developed and implemented comprehensive training programs for staff development and regulatory compliance.
- Ensure ongoing training, competency assessment, and performance coaching aligned with evolving market and business needs
Program Manager – Hub Operations
AllCare Plus Pharmacy, an IQVIA Business
Northborough, MA
02.2019 - 01.2024
- Managed end-to-end reimbursement and patient support hub programs in alignment with contracted scope, payer requirements, and regulatory standards
- Directly supervised and coached a team of 10 Case Managers, assigning caseloads and ensuring coverage across hours of operation
- Oversaw benefit verification, prior authorization, and appeals processes across commercial, Medicare, and Medicaid plans
- Maintained accountability for customer service quality, ensuring timely resolution of patient, provider, and payer inquiries and complaints
- Acted as the primary liaison between manufacturer clients and internal teams, building trusted relationships and ensuring consistent service delivery
- Monitored KPIs and SLAs, proactively identifying risks and driving corrective action plans
- Developed and maintained program-specific SOPs, workflows, and training materials
- Supported program launches, including staffing, training, workflow design, and readiness assessments
- Participated in client audits and quality reviews, ensuring compliance and document accuracy
Lead Case Manager
AllCare Plus Pharmacy, an IQVIA Business
Northborough, MA
05.2017 - 02.2019
- Led daily operational effectiveness of a dedicated team of 10 Care Managers while ensuring adherence to SOPs and SLAs
- Provided direct case management support for more than 300 active patients monthly with a strong focus on adherence and experience
- Completed benefit investigations, prior authorizations, peer-to-peer reviews, and appeals; followed approvals and denials across payers
- Supported healthcare providers with benefit verification guidance and payer criteria for authorizations and appeals
- Scheduled and delegated workload across a team supporting 2,000+ active patients
- Ensured accuracy of CRM documentation, free drug dispensing coordination, and pharmacy follow-ups
- Partnered with QA trainers to support onboarding, training, and continuous staff development
- Served as primary escalation point for territory Sales Account Representatives
- Mentored junior staff on best practices in case management and patient engagement strategies
- Collaborated with healthcare providers to optimize treatment plans and improve patient outcomes
Skills
- Patient Services & Hub Operations
- Leadership
- Team Management & Staff Development
- Case Management Oversight (BV, PA, Appeals)
- Customer Experience & Service Excellence
- KPI / SLA Monitoring, Reporting & Trend Analysis
- CRM Documentation & Data Integrity (Salesforce)
- SOP Development & Compliance
- Cross-Functional Collaboration (Commercial, Market Access, Legal, Compliance)
- Reimbursement Strategy: Commercial, Medicare, Medicaid
- Recruiting, Training & Performance Coaching
- Process Improvement & Operational Efficiency
Accomplishments
- Successfully launched three patient support hub service programs within a five‑year period, delivering operational readiness, staffing, SOP development, and performance stability
- Supported two new drug indication launches within one year, ensuring seamless integration into patient services workflows, reimbursement processes, and customer support operations
Timeline
Director of Patient Support Services – Hub Operations
AllCare Plus Pharmacy, an IQVIA Business
01.2024 - Current
Program Manager – Hub Operations
AllCare Plus Pharmacy, an IQVIA Business
02.2019 - 01.2024
Lead Case Manager
AllCare Plus Pharmacy, an IQVIA Business
05.2017 - 02.2019
Additional Experience
Earlier Management & Operations Experience
Assistant Manager
ExecuTel Communications (2013–2016)
- Hiring, training, scheduling, performance management, SOP development
Office Manager
Gibson Kennels (2007-2011)
- Hiring, training, coaching, scheduling, attendance management, payroll administration
Project Manager
Owens Corning BFS & TEMO (2005–2007)
- Cross functional coordination, documentation, scheduling, customer communication