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Nurse Case Manager

4 months ago

Markham, Canada Bayshore HealthCare Full time
About the Role

Bilingual Nurse Case Manager (NCM) will play an essential role in supporting patients living with HIV disease to improve both their health outcomes and quality of life. NCM offers enrolment and reimbursement support to physicians and to patients. 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. Act as a key resource to physicians who are prescribing this medication and continuous support for renewals, and coverage changes. NCM will also supervise the coordination of monthly injection.

This role is operated on a remote basis and is open to candidates that reside in Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan, Northwest Territories, Nunavut, and Yukon.

A Day in the Life

Assist in completing 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 necessary diagnostic tests and notify physicians of any expired test results that require follow-ups
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

Graduate of registered Nursing Program or registered practical nursing program holding current registration from a provincial licensing body in Canada.
Registered and in good standing with their provincial regulatory body.
Minimum 2 years' experience in Patient Support Programs
Providing excellent customer service skills internally as well as externally
Must be fluent in verbal and written communication and interpersonal skills for both English and French (Applicable for provinces/regions with French language service requirements)
Preference with candidate that has experience with the product
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
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