Bilingual Nurse Case Manager
5 days ago
Summary: Bilingual Nurse Case Manager required to manage reimbursement environment and program support for assigned physicians in a given geographical area.
The Bilingual Nurse Case Manager is a key role within our organization, responsible for managing all aspects of the reimbursement environment and program support for assigned physicians in a given geographical area. As an expert in regional government payer policies and procedures, the NCM supports the regional needs of the client and works directly with the in-house team to facilitate the enrolment, reimbursement, and scheduling process to ensure patients have easy access to their prescribed therapy.
Key Responsibilities:
- Customize program elements to meet the needs of assigned prescribing physicians;
- Review patient status and assist the prescribing physician to complete patient enrolment, follow up with Special Authorization (SA) petitions for public or private coverage with prescribing physicians;
- Proactively assess programs and make suggestions to enhance outcomes and quality of service;
- Complete all relevant reports (program specific reports, expenses, etc.) as per specified timelines and as per required standards.
Patient Support:
- Welcome each patient to the program and capture required patient information;
- Provide therapy guidelines to patients and physicians;
- Ensure patient services are coordinated and tracked, according to KPl's, resulting in expedited access to therapy;
- Identify obstacles to obtaining coverage and channel this information to the Associate Program Manager.
Mentorship/Peer Support:
- Assist in training and development of new CM/NCM as needed;
- Support and assist peers through regular and ongoing communication;
- Develop and maintain a positive relationship with the Program Patient Support team;
- Provide timely patient and clinic information as needed, through specific means used by the program.
Client Interface:
- Develop strong working relationships with physicians and physician office staff, providing additional office support to ensure smooth maintenance of patients enrolled in the program as needed;
- Proactively provide assistance to resolve client issues with regards to assigned physicians;
- Attend scheduled Continuous Medical Education events and report new activities;
- Act as a liaison and provide ongoing feedback to the Patient Assistance Program based on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance.
Competencies:
- Proven track record of leadership abilities, demonstrating proactiveness in identifying customer needs and ownership in executing solutions;
- Strong communication and interpersonal skills;
- Ability to develop professional relationships effectively with external customers and internal associates;
- Organizational skills that demonstrate ability to prioritize and manage deliverables, and to effectively navigate within a matrix organization;
- Ability to establish and encourage patient autonomy;
- Ability to manage challenging patient situations with empathy and patience;
- Ability to understand and apply medical and/or business knowledge to all aspects of role while complying with professional and ethical standards of practice;
- Adaptability;
- Computer skills (Word/Excel).
Qualifications:
- Must be a Nurse (RN, RPN, LPN) in good standing with the respective provincial regulatory body;
- Licensed in more than one province would be an asset;
- English and French bilingualism;
- Case management experience preferred;
- Minimum 2 years of practical clinical experience as a health care professional;
- Experience and background in Multiple Sclerosis is an asset;
- Experience in public or private third-party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support is an asset;
- Background in business administration (pharmaceutical) sales and marketing an asset;
- Knowledge of private and public reimbursement structure, systems, and process is an asset;
- Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation is an asset;
- Valid Driver's License, current auto insurance policy and access to reliable transportation, for regional travel.
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