Bayshore HealthCare Looking for Reimbursement Case Manager (Remote) at Ontario Full Time

ABOUT THE ROLE

To be an expert point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork. Act as a resource to physicians who are prescribing medications and patients who need on-going support. The Case Manager is instrumental in removing any reimbursement access barriers to treatment for patients, thereby ensuring that they can start on therapy as quickly as possible. This position reports into the Associate Program Manager. The Case Manager thrives in an environment that emphasizes teamwork and accountability, possesses a deep willingness to serve customers, and drives positive customer experiences in a fast‐paced work environment. You can be based anywhere in Canada as this is a work from home position.

A DAY IN THE LIFE

• Ensure patient has been enrolled in the patient support program (PSP). Set the tone for a warm welcome into the program.
• Provide direct telephone assistance to patients requiring reimbursement support.
• Develop strong relationships with patients, caregivers, and their healthcare team by infusing confidence, trust, security, and relief.
• Facilitate a patient’s access to a particular medication by offering reimbursement navigation services.
• Investigate reimbursement options available to the patient and maximize the patient’s coverage via private and public payers, while minimizing the financial assistance offered through the PSP and/or out-of-pocket expenses for the patient.
• Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
• Liaise with PSP team to ensure optimal patient support and communication.
• Maintain ongoing and transparent communication with the patient’s healthcare team.
• Diligent record-keeping to ensure continuous care and exceptional customer and patient experience.
• Uncover and proactively identify gaps and opportunities for improvement in patient experience.
• Through patient-oriented solutions, manage challenging patient situations with empathy and patience.
• Work with the site representatives to support specific customer needs.
• Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.
• Provide updates to stakeholders as requested and required.
• Perform data entry, answer inbound calls, make outbound calls, manage e-mail and fax software, and perform general administrative functions including faxing and filing.
• Must be able to identify and report adverse events to Health Canada (if applicable) and enter into source system and third-party systems.
• Report and document adverse events as per pharmacovigilance requirements.
• Participate in ongoing internal and/or external continuing education activities.
• Adhere to Bayshore Policies and Procedures.
• Participate in quality activities and continuous improvement initiatives in keeping with the company’s Quality Management System as well as specific performance indicators for the project.
• Participate in proactive Health & Safety activities while performing all duties. Is responsible to notify immediate supervisor of any Health & Safety risks or concerns.
• Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel.
• Complete other tasks as requested.

WHAT YOU BRING TO THE TEAM

• Post-secondary education or equivalent.
• Reimbursement experience and/or a willingness to learn.
• Bilingualism is an asset, but not required.
• Understanding of provincial and private coverage criteria and how to navigate the Canadian drug coverage landscape.
• Familiarity with the Special Authorization (SA) process for both public and private insurance in assigned territory.
• Experience in the healthcare, pharmaceutical, or insurance industry would be an asset; experience with patients with cancer or rare diseases would also be an asset.
• Strong customer service, communication, problem-solving and interpersonal skills required.
• Demonstrates sensitivity and commitment to utilizing a patient-centric approach; is adept to responding to a patient’s emotional, educational, and health literacy needs.
• Demonstrates cultural competency.
• Making decisions using sound judgment, and meeting deadlines.
• Ease of working in a paperless environment.
• Proven ability to work autonomously within a team environment, in a remote/virtual setting.
• Strong sense of organization, attention to detail, and ability to multi-task.
• Comfortable working in a contact center environment.
• Proficient in Microsoft Office applications (Outlook, Word, and Excel).