Field Case Manager – 15 months contract, RN/RPN/LPN

Role Overview

• Customize program elements to meet the needs of assigned prescribing physicians
• Review patient status and assist the prescribing physician to complete patient enrolment
• Prepare payer forms to access public or private coverage by reviewing patient charts
• Identify obstacles to obtaining coverage and channel this information to the Program Manager
• Develop strong working relationships with physicians and physician office staff
• Proactively provide assistance to resolve issues with regards to assigned physicians
• Provide training to physicians and clinics on program and new initiatives approved by the manufacturer
• Acts as a liaison and provide ongoing feedback to the Program Manager
• Complete all relevant reports as per specified timelines and as per required standards
• Welcome each patient to the program and capture required patient information
• Provide reimbursement payer guidelines to patients and physicians
• Ensure patient services are coordinated and tracked, according to KPI’s
• Coordinate private and public coverage activity between patient, physician and insurers
• Confirm outcome of reimbursement navigation with the patient
• Provide information and navigate patient through financial assistance
• Assist patient with pharmacy selection and coordinate drug delivery
• Report Adverse Events / Severe Adverse Events following program Standard Operating Procedures
• Assist in training and development of new FCM as needed
• Develop and maintain a positive relationship with the Patient Support Program team
• Participate in scheduled physician meetings with Pharmaceutical team
• Complete all relevant reports as per specified timelines and as per required standards.

Requirements

• A Bachelor’s degree in health care or a related discipline, or a nurse diploma
• Requires a minimum five (5) years, in the healthcare, pharmaceutical or insurance industry or related experience
• Licensed Nurse (RN or RPN/LPN) with active registration from the College of Nurses in the province of employment is required.
• Case management experience preferred; minimum three (3) years nursing experience in a clinic setting is an asset
• Available to travel within an assigned territory, some overnight travel may be required
• Valid Driver’s License, current auto insurance policy and access to reliable transportation, for regional travel
• Experience and background in various therapeutic areas is an asset
• Background in business administration (pharmaceutical) sales and marketing an asset
• Knowledge of private and public reimbursement structure, systems, and process
• Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation
• Strong analytical skills including interpretation of regulation and legislation
• Fluency in French and/or English may be required depending on program and geographic location.

Benefits

• medical, dental, and vision care
• comprehensive suite of benefits focusing on wellness
• support for working families
• backup dependent care
• adoption assistance
• infertility coverage
• family building support
• behavioral health solutions
• paid parental leave
• paid caregiver leave
• training programs
• professional development resources
• mentorship programs
• employee resource groups
• volunteer activities