Case Manager

Bayshore HealthCare; Mississauga; On-site; CAD 50,000 - 70,000; Full time

Job summary

Bayshore HealthCare is looking for a dedicated Case Manager to provide exceptional support for patients and healthcare professionals involved in the Ipsencares program. In this role, you will assist patients with program paperwork, facilitate medication access, and develop strong relationships with patients and their healthcare teams.

The ideal candidate should have a post-secondary education, bilingual capabilities in English and French, and experience in the healthcare or insurance sectors. This position emphasizes teamwork, empathy, and a commitment to customer care.

Qualifications

• Understanding of provincial and private coverage criteria and drug coverage landscape.
• Experience in healthcare, pharmaceutical, or insurance industry is an asset.
• Strong attention to detail and ability to work autonomously.

Responsibilities

• Ensure patient enrollment in the support program and provide direct assistance.
• Develop relationships with patients and healthcare teams.
• Coordinate with insurers for optimization of drug coverage.

Skills

Exceptional customer service

Fluent in English and French

Problem-solving skills

Interpersonal skills

Education

Post-secondary education or equivalent

Tools

Excel

Word

Outlook

Job description

Job Summary

On the Ipsencares program, the Case Manager (CM) is expert point of contact offering case management support services to patients and physicians for Iqirvo. The CM will assist the patients, physicians, and nurses with the completion of all program-specific paperwork. The CM will act as a resource to physicians who are prescribing medications and patients who need ongoing support. They are instrumental in removing any reimbursement access barriers to treatment for patients, thereby ensuring that they can start on therapy as quickly as possible. They thrive in an environment that emphasizes teamwork and accountability, possesses a deep willingness to serve customers, and drives positive customer experiences in a fast‑paced work environment while showing flexibility to adapt to competing demands across the portfolio as required. This role reports directly to the Reimbursement Associate Program Manager, ensuring alignment with program objectives and continuous improvement in patient and provider support services.

Responsibilities

• Ensure patient has been enrolled in the patient support program (PSP). Set the tone for a warm welcome into the program.
• Provide direct telephone assistance to patients requiring reimbursement support.
• Provide patients and physicians with direct toll-free number.
• Develop strong relationships with patients, caregivers, and their healthcare team by infusing confidence, trust, security, and relief.
• Facilitate a patient’s access to a particular medication by offering reimbursement navigation services.
• Investigate reimbursement options available to the patient and maximize the patient’s coverage via private and public payers, while minimizing the financial assistance offered through the PSP and/or out‑of‑pocket expenses for the patient.
• Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
• Coordinate with pharmacy drug coverage and dispensing. Troubleshoot any filling/billing issues as required.
• Liaise with PSP team to ensure optimal patient support and communication, if applicable.
• Maintain ongoing and transparent communication with the patient’s healthcare team.
• Diligent record-keeping to ensure continuous care and exceptional customer and patient experience.
• Uncover and proactively identify gaps and opportunities for improvement in patient experience.
• Through patient-oriented solutions, manage challenging patient situations with empathy and patience.
• Work with the site representatives to support specific customer needs.
• Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.
• Provide updates to internal and external stakeholders as requested and required.
• Perform data entry, answer inbound calls, make outbound calls, manage e-mail and fax software, and perform general administrative functions including faxing and filing.
• Must be able to identify and report Adverse Events to Health Canada and enter into source system and third-party systems, as applicable.
• Report and document adverse events as per pharmacovigilance requirements.
• Participate in ongoing internal and/or external continuing education activities.
• Adhere to Bayshore Policies and Procedures.
• 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 pharmaceutical partner(s) and corporate information and discusses same only with appropriate Bayshore personnel.
• Complete other tasks as requested.

Qualifications

• Education
  Completion of post-secondary education or equivalent
• Experience
  Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset
• Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders
• 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)
• Experience in the healthcare, pharmaceutical, or insurance industry would be an asset
• Strong customer service, communication, problem-solving and interpersonal skills required.
• Demonstrates sensitivity and commitment to utilizing a patient-centric approach; is adept at responding to a patient’s emotional, educational, and health literacy needs
• Making decisions using sound judgment, and meeting deadlines.
• Ease of working in a paperless environment.
• Mindful of accuracy and thoroughness of data entry for reporting requirements.
• Strong sense of organization, attention to detail, and ability to multi-task.
• Excellent written and verbal communication and interpersonal skills.
• Strong computer and technical skills: Excel, Word, Outlook, tablets, web portals/internet use
• Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
• Established high speed internet access from home office