Michele Stuhr
Reno,NV
Summary
Highly skilled and enthusiastic professional with more than 20 years of experience. Focused on insurance reimbursement case management, and patient support services in the Pharmaceutical Industry for Rare Diseases/Specialty Medications.
Medicare, Medicaid and commercial insurance expertise. Extensive background working with health care staff, sales teams, HUBS, and Specialty Pharmacies.
Strong verbal and written communication, problem solving skills and is a team player.
Effectively manage multiple high-priority projects and take pride in providing exemplary customer service
Overview
19
19
years of professional experience
Work History
Care Coordinator
Amylyx Pharmaceuticals
Cambridge, MA/Remote
04.2023 - Current
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Used company software and databases to maintain records of services performed and patient conditions.
- Provided emotional support for patients and families during difficult times, fostering resilience and coping skills.
- Conducted regular evaluations of care plan effectiveness, making necessary adjustments based on feedback from patients and providers.
- Built strong relationships with patients to deliver emotional support and companionship.
- Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
- Assessed patient needs and connected them with appropriate resources to for patient assistance, copay, etc.
- Improved communication among healthcare providers, streamlining the coordination of services for patients.
- Provided product and disease state education to patients and their caregivers using approved materials.
- Partnered with 3rd Party Back End Vendor (HUB) services, and Specialty Pharmacies to ensure timely benefit investigations and provide reimbursement education.
- Ensured compliance to all procedures, policies, and adverse event reporting requirements.
- Maintained knowledge of Medicare, Medicaid, and commercial plans coverage policies.
Reimbursement Case Manager
Caremetx
Remote
11.2014 - 03.2023
- Assisting patients, clinics, and sales team on obtaining reimbursement cover for self injectable medications, and infusion therapy coverage for rare diseases.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Covered a large regional area.
- Contacted patients regularly to check in on adherence and compliance.
- Conducted eligibility checks, benefit investigations, and assisted with prior authorizations and appeals.
Case Manager
Premier Source/Amerisource Bergen (Lash)
Remove
03.2007 - 11.2016
- Assisted patients, clinics, and sales account teams with obtaining medication coverage/reimbursement in the United States for Specialty Medications for Rare Diseases.
- Escalated payer issues to the appropriate teams within National Accounts.
- Enhanced communication between patients and providers through consistent follow-ups and progress updates.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Educated patients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Assisted in creating process, SOP's and training for new team members
- Proficient in HIPAA, CPT Codes, and ICD 9/10.
Team Lead-Patient Assistance Program
Genentech Access Solutions
South San Francisco, CA
06.2005 - 02.2007
- Supported and led at team of 14 direct reports/case managers
- Trained new team members by relaying information on company procedures and safety requirements.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Coached team members in techniques necessary to complete job tasks.
- Assisted in launching 3 new specialty medications and creating processes for the patient assistance program.
- Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
Education
No Degree - Biological And Physical Sciences
College of San Mateo
San Mateo, CAHigh School Diploma -
Hillsdale High School
San Mateo, CA06.1990
Skills
- Case Management
- Patient Education
- Organizational Skills
- Medical terminology understanding
- Documentation proficiency
- Multidisciplinary team collaboration
- Process Improvements
- Medical Terminology
- Insurance Practices/Drug utilization review
- HIPAA Guidelines
- Patient Advocacy
Timeline
Care Coordinator
Amylyx Pharmaceuticals
04.2023 - Current
Reimbursement Case Manager
Caremetx
11.2014 - 03.2023
Case Manager
Premier Source/Amerisource Bergen (Lash)
03.2007 - 11.2016
Team Lead-Patient Assistance Program
Genentech Access Solutions
06.2005 - 02.2007
No Degree - Biological And Physical Sciences
College of San Mateo
High School Diploma -
Hillsdale High School