Job Description
About the Role
The Nurse Case Manager (NCM) will play an essential role in supporting patients with reimbursement support to physicians and medical case management services to patients.
Assist the physician with the completion of all program specific paperwork and follow up on submissions pertaining to obtaining drug reimbursement / coverage through private and provincial drug formularies to ensure patients have access to their prescribed treatments in a timely manner.
Act as a resource to physicians who are prescribing this medication and continuous support for patients for on going support, renewals, and coverage changes.
This is a remote contract position for up to 16 months , open to candidates residing in any Canadian province or territory and must be available to work from 9 : 00am to 5 : 00pm Eastern Standard Time (EST).
A Day in the Life
- Assist in completing patient enrolment; including gathering all pertinent and appropriate information to complete the necessary forms (private and / or provincial insurance) in a concise, organized, and professional manner
- Liaise and advocate with third-party providers and provincial governments as necessary to determine coverage options
- Review patient charts (paper and electronic based); keep electronic charts
- Ensure patients are scheduled for necessary diagnostic tests and notify physicians of any expired test results that require follow-ups
- Complete Welcome Call activities with the patient according to defined scripts
- Review Post Injection Reports to confirm next appointment is scheduled and data integrity of the report against the physician order
- Track missing Post Injection Reports
- Facilitate any required communication with physicians, Patient Support Programs, or other health care professionals involved in the patient’s circle of care
- Follow up / advocate until a decision is received, ideally securing coverage for the patient
- Work closely with the manufacturer local sales representatives to support specific physician’s and staff needs
- Offer and / or provide educational training to patients and physicians on product’s administration
- Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics
- Coordinate and schedule patients at appropriate injection locations (home, clinic,
- Provide updates to stakeholders based on observations
- Ensure patient records are maintained and data-accurate to meet program reporting requirements
- Must be able to identify and report Adverse Events to Health Canada, Med Info, and enter into source system and third-party systems
- Report and document Adverse Events as per Pharmacovigilance requirements
- 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
- Maintain confidentiality of client and corporate information and discuss same only with appropriate Bayshore personnel
- Complete all relevant reports (time sheets, expenses, mileage, reports, as per specified timelines and Bayshore’s policy
- Complete product complaint reports
- Adhere to Bayshore and manufacturer Policies and Procedures
- Complete other tasks, as requested
Job Qualification
What You Bring to the Team
- Graduate of registered Nursing Program or registered practical nursing program holding current registration from a provincial licensing body in Canada.
- Registered and in good standing with their provincial regulatory body.
- Minimum 2 years’ experience in Patient Support Programs
- Oncology experience is considered a valuable asset
- Providing excellent customer service skills internally as well as externally
- Must be fluent in verbal and written communication and interpersonal skills for both English and French (Applicable for provinces / regions with French language service requirements)
- Preference with candidate that has experience with the product
- Reimbursement experience
- Understanding of provincial and private coverage criteria and how to navigate the Canadian drug coverage landscape
- Familiarity with the Special Authorization process for both public and private insurance in assigned territory
- Strong computer and technical skills : Excel, Word, Outlook, tablets, web portals / internet use
- Strong critical thinking and problem-solving skills
- Making decisions using sound judgment
- Accurate data collection and data
- Ease with working in a paperless environment
- Ability to drive for results
- Proven ability to work in a team environment
- Ability to resolve conflict in a professional matter
- Strong sense of organization and attention to detail
- Self-regulation of time management and the ability to multi-task and adhere to deadlines
- Familiarity with PIPEDA and how it applies in a confidential patient environment
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