Bilingual Field Case Manager

Role Overview

• Practice Management
• 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
• Document previous therapies and tests in order to complete the payer forms
• Identify obstacles to obtaining coverage and channel this information to the Program Manager
• Develop strong working relationships with physicians and physician office staff
• 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 (program specific reports, expenses, etc.) as per specified timelines
• 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
• Assist patient with coordination of therapy and ongoing therapy status
• Refer the patient to contact their healthcare provider should the patient have clinical questions
• Report Adverse Events / Severe Adverse Events following program Standard Operating Procedures
• Assist in training and development of new FCM as needed
• Support and assist peers through regular and ongoing communication
• Develop and maintain a positive relationship with the Patient Support Program team
• Provide timely patient and clinic information as needed, through specific means used by the program.

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

• Health insurance
• Retirement plans
• Paid parental leave
• Paid caregiver leave
• Paid time off
• Flexible working hours
• Professional development opportunities
• Job training programs