Nurse Case Manager

4 weeks ago

Markham, Canada Bayshore HealthCare Full time
About 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 with the completion of all program-specific paperwork including Special Authorizations, appeals, prescription renewals, and medical clarifications. 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. The Nurse Case Manager will support with scheduling patients and reviewing Post Injection Reports to ensure adequate injection and/or training is completed. Submit Adverse Events as required by Health Canada.

This is a fully remote position that reports under Bayshore Specialty RX located at Mississauga, ON. As a Nurse Case Manager, you will be able to work from anywhere in Canada, including the following provinces: Ontario, Quebec, British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia, New Brunswick, Newfoundland and Labrador, and Prince Edward Island.

A Day in the Life

Assist the Field Nurse Case Manager to complete 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 blood work and notify physicians of expired blood work results
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, etc.)
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, etc.) 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

Registered Nurse or Registered Practical Nurse (RN/RPN) license
Preference with candidate that has experience with the product
Registered and in good standing with the College of Nurses
Minimum 2 years' experience in Patient Support Programs
Providing excellent customer service skills internally as well as externally
Excellent verbal and written communication skills and interpersonal skills; English and French if servicing Quebec and New Brunswick
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 integrity
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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