Case Manager

Job Summary

To be an expert point of contact offering case management support services to patients. Assist patients, physicians, and nurses with the completion of all program-specific paperwork. Act as a resource to physicians who prescribe medications and to patients who need ongoing support. The Case Manager is instrumental in removing reimbursement access barriers to treatment for patients, thereby ensuring that they can start therapy as quickly as possible. 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.

Duties and Responsibilities

• Ensure patient has been enrolled in the patient support program (PSP) and give a warm welcome to the program.
• Provide direct telephone assistance to patients through welcome calls, reimbursement support, follow‑up calls, and both inbound and outbound call support.
• Develop strong relationships with patients, caregivers, and their healthcare team by conveying 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, minimizing out‑of‑pocket expenses for the patient.
• Gather all pertinent and appropriate information from the prescribing physician to complete the necessary forms in a concise, organized, and professional manner.
• 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 the PSP team to ensure optimal patient support and communication.
• Maintain ongoing, transparent communication with the patient's healthcare team regarding patient care and reimbursement outcomes as needed. Follow up with patient at least annually to confirm any changes to coverage.
• Perform diligent record‑keeping to ensure continuous care and exceptional customer and 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.
• Perform data entry, answer inbound calls, make outbound calls, manage email and fax software, and perform general administrative functions including faxing and filing.
• Identify and report adverse events to Health Canada (if applicable) and enter sources into the 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 Bay​shore Policies and Procedures.
• Participate in quality activities and continuous improvement initiatives in keeping with the company’s Quality Management System and specific performance indicators for the project.
• Participate in proactive Health & Safety activities while performing all duties. Notify immediate supervisor of any Health & Safety risks or concerns.
• Maintain confidentiality of client and corporate information and discuss it only with appropriate Bay​shore personnel.
• Complete other tasks as requested.

Qualifications

Primary Location

ON-Mississauga

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