Case Manager

6 months ago

Markham, Canada Sentrex Health Solutions Inc. Full time

**Position Type**: Fixed-Term Full Time

**Department**: Patient Programs

**Work Location**: Ontario

**Work Arrangement**: Hybrid, travel up to 30% within Ontario

**Work Hours**: Monday to Friday, 9-5 EST

A proudly Canadian company, Sentrex Health Solutions is a fully integrated specialty distributor and patient support provider for pharmaceutical manufacturers, physicians, and their patients. We provide innovative solutions focused on ensuring patients have access and the support they need to maximize their treatment outcomes. We do this through strategic distribution models and patient support programs that are backed by powerful, integrated technology and experienced, cross-functional teams. Our core capabilities **include Specialty Pharmacy Services, Customized Solutions for Warehouse, Wholesale & Distribution, Patient Support Programs, as well as HCP & Clinic Services.**

**Come and join our team But first, let us tell you why we love working here**:

- We are 100% Canadian with locations across the country
- State-of-the-art facilities to provide high-quality products and services
- The opportunity to be a part of a winning, high-performing team
- Collaborative, engaging workplace culture - **we are passionate about our people**:

- Flexible working environment that promotes a healthy work-life balance
- Diverse and inclusive culture where your talent and commitment to excellence is welcomed and valued
- High-growth environment that provides opportunities for learning and growth supported by our Employee Development Program and industry-leading, in-house corporate training offered throughout the year
- Quarterly virtual social events

**The Opportunity**:
The Case Manager is responsible for managing all the aspects of the enrollment, reimbursement process, and service coordination for patients who has been prescribed the drug by physicians. The Case Manager will provide drug coverage support to physicians and patients, follow up on submissions pertaining to obtaining coverage through private and provincial drug plans, ensure patients have access to their prescribed treatments in a timely manner, and provide continuous support for patients through excellent communication skills and available resources to ensure patients have easy access to their prescribed therapy.

**A Day in the Life (What you will do here)**:

- Responsible for the timely enrollment of the patient into the Patient Support Program.
- Collaborate with the patient, insurer and physician regarding the documentation necessary for maximal reimbursement coverage, including the investigation of all public and private insurers and supporting employer escalations as required.
- Reviews patient status and assists the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests.
- Provides therapy guidelines/education on the program to manage patient and physician expectations.
- Collects information and conducts patient financial assessment eligibility based on program guidelines.
- Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy.
- Reports Adverse Events / Severe Adverse Events (AE / SAEs) following approved SOPs.
- Maintain service levels in case management, including telephone answer rates, time to initial contact with the patient, Adverse Events reported within twenty-four hours of receipt and any other KPIs established as the Program level.
- Electronically updates the Customer Relationship Management (CRM) tool by providing timely patient and clinic information.
- Fosters and promotes a spirit of teamwork while working with internal patient support teams.
- Acts a liaison and provides ongoing feedback to the Program Manager based-on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance.
- Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Assistant Program Manager.
- Completes all relevant reports (time sheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards.
- Additional duties as determined by your Manager

**What you need to ensure you are set up for success**:

- A Bachelor's degree
- Access to a reliable vehicle and be able to travel up to 30% within Ontario
- Experience with reimbursement billing, special access, the appeals process, and conducting field-based reimbursement support and consultation is an asset
- Knowledge of private and public reimbursement structure, systems, and the process is an asset
- Experience with ophthalmology is an asset
- Must be able to work from home and have a quiet, private home office space
- Excellent verbal and written communication skills in English
- Strong analytical skills including interpretation of regulation and legislation
- Advanced knowledg

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