Nurse Case Manager

2 weeks ago

Toronto, Ontario, Canada Bayshore HealthCare Full time
JOB SUMMARY
The Nurse Case Manager (NCM) will play an essential role in supporting patients living with a dermatological disease to improve both their health outcomes and quality of life. The NCM offers enrolment and reimbursement support to physicians and medical case management services to patients. They assist the physician with the completion of all program-specific paperwork and 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 NCM acts as a key resource to physicians who are prescribing this medication and provides continuous support for renewals and coverage changes.

DUTIES AND RESPONSIBILITIES

• Liaise and advocate with third-party providers and provincial governments as necessary to determine coverage options.

• 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.

• Facilitate any required communication with physicians, Patient Assistant Programs, or other health care professionals involved in the patients' 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 the product's administration.

• Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.

• Provide updates to stakeholders based on observations in the field and physician's feedback.

• Ensure patient records are maintained and data accurate to meet program reporting requirements.

• Identify and report Adverse Events (AEs) 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.

• Travel to physician's offices on a regular basis as requested by the physician's office.

• 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.

QUALIFICATIONS

Experience

• Registered Nurse or Registered Practical Nurse (RN/RPN) License.

• Preference for candidates with experience in the disease state.

• Registered and in good standing with the College of Nurses.

• Excellent written and verbal communication skills in English.

• Minimum 2 years' experience in Patient Support Programs.

• Provide excellent customer service skills internally as well as externally.

• Excellent verbal and written communication skills and interpersonal skills; English and French considered an asset.

• Reimbursement experience:
o Understanding of provincial and private coverage criteria and how to navigate the Canadian Drug Coverage Landscape.
o 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.

• Make decisions using sound judgment and meet 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 manner.

• 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.

• Valid driver's license with less than 2 infractions in the past 2 years.

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