Bilingual Reimbursement Case Manager/specialist

6 months ago

Mississauga, Canada Bayshore HealthCare Full time

**THIS POSITION IS REMOTE FROM ANYWHERE IN CANADA**

***CANDIDATES MUST BE FLUENTLY BILINGUAL IN BOTH ENLGLISH AND FRENCH**

**ABOUT THE ROLE**:
The Bilingual Non -Nurse Case Manager will be the point of contact offering 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 access through various means 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 via phone for renewals, and coverage changes.

**A DAY IN THE LIFE**:

- Complete outbound and inbound calls to patients, HCPs and other key players to support patients through their treatment journey.
- Gather all pertinent and appropriate information from the prescribing physician to complete any necessary forms for private and/or provincial insurance in a concise, organized and professional manner.
- Follow-up/advocate until a decision is received.
- Proactively offer counseling, advocacy and assistance for patients.
- Liaise and advocate with third-party providers and provincial governments as necessary to determine coverage options.
- Complete Reimbursement Navigation & complete other tasks as requested
- Follow-up/advocate until a decision is received, ideally securing coverage for the patient.
- Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, the client and clinics.
- Ensure ongoing compliance of treatment as well as the completion of ongoing symptom support for patients
- Provide updates to stakeholders as requested.
- Participate in ongoing internal and/or external continuing education activities
- Adhere to Bayshore Policies and Procedures
- Must be able to identify and report AE’s to health Canada, Med Info and enter into source system
- Report and document Adverse Events as per Pharmacovigilance requirements
- Provide telehealth support and telephone follow up to patients at specific intervals as set out in the program SOP or SOW
- 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
- May require to travel on occasions

Job Qualification

**WHAT YOU BRING TO THE TEAM**
- Experience with oncology patients considered a strong asset
- Must have a proven track record with excellent customer services skills internally as well as externally
- Experience working with Patient Support Programs (Asset)
- Excellent verbal and written communication skills and interpersonal skills
- English & French
- 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
- Making decisions using sound judgment, and meeting deadlines.
- 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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