Nurse Case Manager, Disability Management
3 weeks ago
This position will be a single point of contact offering case management support services to plan members. Act as a resource to Pharmacies, and Patient Support Programs and continuous support for plan members for on‐going support with coverage, access to medications, and reimbursement navigation. This position reports into the Program Manager, Payor Solutions.
Pay rate - $57,000 to $60,000
DUTIES AND RESPONSIBILITIES
Liaise and advocate with insurance companies, Patient Support Programs, physician’ offices and healthcare professionals to maximize reimbursement solutions
Encourage plan member enrollment in the applicable Patient Support Program
Completes and/or reviews Prior Authorization forms prior to submission to insurers, when the plan member is not enrolled within a Patient Support Program
Maintain in depth knowledge of public, private, and federal funding mechanisms nationally for all program drugs.
Maintain detailed electronic notes in the plan members file
Gather all pertinent and appropriate coverage information from the plan member or Patient Support Program to complete pharmacy referrals (Private and/or Public insurance, or financial assistance) in a concise, organized, and professional manner.
Proactively offer counseling, advocacy, and assistance for plan members.
Act as a central resource liaison for program stakeholders, which include private and public insurers, pharmacies, nurses, and Patient Support Programs.
Adjudicate prescriptions to external payers and support Bayshore Pharmacies with troubleshooting any adjudication error or reimbursement issues identified.
Communicates with plan members’ third-party plans to troubleshoot rejected claims.
Coordinate specialty pharmacy services once funding has been secured
Provide updates to stakeholders as requested.
Potential for large amount of telephone support required.
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.
Job Qualification
.Education and/ or Experience
Secondary School Diploma.
Minimum of 2 years’ experience in customer service, in an office or pharmacy setting
Experience in the insurance, healthcare, pharmaceutical and Private/Public payers within Canada
Strong computer and technical skills: Excel, Word, Outlook
Experience in specialty pharmacy workflow with Kroll and NAV software
Professional / courteous / efficient telephone manner
Proven ability to organize time, set priorities and multi-task to meet various competing work deadlines
Candidate must have strong communication and interpersonal skills
Ability to work independently and in a team environment
Attention to detail
Excellent written and verbal communication skills
Comfort with investigating and making decisions using sound judgment
Familiarity with PIPEDA and how it applies in a confidential plan member environment.
Bilingualism, French/English is an asset.
“At Bayshore Healthcare, our commitment to Equity, Diversity & Inclusion is our strength. This is how we bring our vision of being the difference in the lives of those we care for, work with and in our communities. We have a great sense of pride in creating a culture of belonging, where individual differences are embraced and celebrated, through programs, resources and policies that support each individuals purpose, potential and wellbeing.”
Bayshore operates in accordance with the Accessibility for Ontarians with Disabilities Act, and applicable Provincial Human Rights Codes.
-
Disability Case Manager
1 month ago
Toronto, Canada ACCLAIM ABILITY MANAGEMENT INC. Full time**Disabiliy Case Manager** Are you passionate about health, wellness and playing a positive role in assisting individuals in their return to work? Do you enjoy working in a dynamic, flexible and collaborative environment where you are encouraged to share your ideas? Are you well organized with strong customer service skills and able to demonstrate empathy?...
-
Disability Case Manager
4 weeks ago
Toronto, Canada Air Canada Full time**Description** **Being part of Air Canada is to become part of an iconic Canadian symbol, recently ranked the best Airline in North America. Let your career take flight by joining our diverse and vibrant team at the leading edge of passenger aviation.** - Management of disability claims arising from illness or injury of employees - Facilitate the...
-
Disability Case Manager
4 weeks ago
Toronto, Canada Air Canada Full time**Description** **Being part of Air Canada is to become part of an iconic Canadian symbol, recently ranked the best Airline in North America. Let your career take flight by joining our diverse and vibrant team at the leading edge of passenger aviation.** **Responsibilities**: - Management of disability claims arising from illness or injury of employees -...
-
Nurse Case Manager
4 weeks ago
Markham, ON, Canada Bayshore HealthCare Full timeAbout the RoleThe Nurse Case Manager (NCM) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. Complete enrolment calls, respond to patient inquiries and offer reimbursement support to physicians and medical case management services to patients. Assist the Field Nurse...
-
Nurse Case Manager
4 weeks ago
Markham, ON, Canada Bayshore HealthCare Full timeAbout the RoleThe Nurse Case Manager (NCM) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. Complete enrolment calls, respond to patient inquiries and offer reimbursement support to physicians and medical case management services to patients. Assist the Field Nurse...
-
Nurse Case Manager
4 weeks ago
Markham, ON, Canada Bayshore HealthCare Full timeAbout the Role The Nurse Case Manager (NCM) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. Complete enrolment calls, respond to patient inquiries and offer reimbursement support to physicians and medical case management services to patients. Assist the Field...
-
Nurse Case Manager
3 weeks ago
Toronto, Canada BioScript Solutions Full timeYour future starts here We are looking for an engaged individual to take on the role of Nurse Case Manager. This role is responsible for undertaking the management of specific cases that are assigned to them in regards to patient reimbursement and coordination for the NavieGo branch of the organization. The Nurse Case Manager is responsible for overall...
-
Disability Case Manager
1 month ago
Toronto, Canada Beneva Full timeJob Posting Title: Disability Case Manager Status: Regular **Job Description**: Are you looking to be a part of a growing and dynamic team within a leading national life insurance company? Beneva Insurance in seeking a seasoned disability case manager to manage a mixture of short and long-term disability claims. As a disability case manager, you will be...
-
Licensed Practical Nurse
4 days ago
Espanola, ON, Canada Professional Case Management (PCM) Full time €29 - €32Hiring Licensed Practical Nurses in New Mexico **Professional Case Management, the leader in home healthcare, is now hiring LPN's/LVN's to provide in-home healthcare services to help those who have served our country! Benefit from one-on-one patient relationships and from the satisfaction of enhancing clients' health, quality of life and peace of mind. You...
-
Disability Case Manager
1 month ago
Toronto, Canada Canada Life Full timeJob Description We are looking for a Disability Case Manager in Toronto. Are you looking for an environment where integrity, partnership, excellence and constant improvement are at the heart of your everyday life? In our organization, we believe in working collaboratively in a team environment to share our knowledge with one another and to...
-
Bilingual Non Nurse Case Manager
3 weeks ago
Toronto, ON, Canada Bayshore HealthCare Full timeThis "remote" position will be a point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork if needed for PSP Hub Programs. Act as a resource to physicians who are prescribing medications and patients who need on-going support.DUTIES AND...
-
Bilingual Non Nurse Case Manager
3 weeks ago
Toronto, ON, Canada Bayshore HealthCare Full timeThis "remote" position will be a point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork if needed for PSP Hub Programs. Act as a resource to physicians who are prescribing medications and patients who need on-going support.DUTIES AND...
-
Bilingual Non Nurse Case Manager
3 weeks ago
Toronto, ON, Canada Bayshore HealthCare Full timeThis "remote" position will be a point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork if needed for PSP Hub Programs. Act as a resource to physicians who are prescribing medications and patients who need on-going support. DUTIES AND...
-
Disability Case Manager Ii
1 month ago
Toronto, Canada Beneva Full timeJob Posting Title: Disability Case Manager II Status: Regular **Job Description**: Are you looking to be a part of a growing and dynamic team within a leading national life insurance company? Beneva Insurance in seeking a seasoned bilingual and non-bilingual disability case manager to manage a mixture of short and long-term disability claims. As a...
-
Bilingual Nurse Case Manager
3 weeks ago
Toronto, ON, Canada Bayshore HealthCare Full timeThis "remote" position will be a point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork if needed for PSP Hub Programs. Act as a resource to physicians who are prescribing medications and patients who need on-going support. DUTIES AND...
-
Bilingual Nurse Case Manager
3 weeks ago
Toronto, Canada BioScript Solutions Full timeYour future starts here We are looking for an engaged individual to take on the role of Nurse Case Manager. This role is responsible for undertaking the management of specific cases that are assigned to them in regards to patient reimbursement and coordination for the NavieGo branch of the organization. The Nurse Case Manager is responsible for overall...
-
Nurse Case Manager
6 days ago
Markham, ON, Canada Bayshore HealthCare Full timeAbout the RoleBilingual Nurse Case Manager (NCM) will play an essential role in supporting patients living with HIV disease to improve both their health outcomes and quality of life. NCM offers enrolment and reimbursement support to physicians and to patients. Assist the physician with the completion of all program-specific paperwork and follow-up on...
-
Nurse Case Manager
6 days ago
Markham, ON, Canada Bayshore HealthCare Full timeAbout the RoleBilingual Nurse Case Manager (NCM) will play an essential role in supporting patients living with HIV disease to improve both their health outcomes and quality of life. NCM offers enrolment and reimbursement support to physicians and to patients. Assist the physician with the completion of all program-specific paperwork and follow-up on...
-
Nurse Case Manager
2 days ago
Markham, ON, Canada Bayshore HealthCare Full timeAbout the RoleNurse Case Manager (NCM) will play an essential role in supporting patients living with HIV disease to improve both their health outcomes and quality of life. NCM offers enrolment and reimbursement support to physicians and to patients. Assist the physician with the completion of all program-specific paperwork and follow-up on submissions...
-
Bilingual Non Nurse Case Manager
3 weeks ago
Toronto, Canada Bayshore HealthCare Full timeThis "remote" position will be a point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork if needed for PSP Hub Programs. Act as a resource to physicians who are prescribing medications and patients who need on-going support.DUTIES AND...
