Case Manager

Bayshore HealthCare; Ontario; On-site; CAD 60,000 - 75,000; Full time

Job summary

A leading healthcare company is seeking a Case Manager to provide essential support services to patients. The role involves assisting patients with medication access, navigating insurance processes, and ensuring a positive customer experience. The ideal candidate will possess strong communication skills, a patient-centric approach, and the ability to work in a fast-paced environment. This position emphasizes teamwork and accountability while managing patient care effectively.

Qualifications

• Fluent in both French and English an asset.
• Understanding of provincial and private coverage criteria.
• Proven ability to work autonomously within a team environment.

Responsibilities

• Provide direct telephone assistance to patients.
• Facilitate a patient's access to medication through reimbursement navigation.
• Maintain ongoing communication with the patient's healthcare team.

Skills

Customer Service

Communication

Problem-Solving

Education

Experience in healthcare, pharmaceutical, or insurance industry

Tools

Excel

Word

Outlook

Job description

To be an expert point of contact offering case management support services to patients. Assist the patients, physicians, and nurses with the completion of all program-specific paperwork. Act as a resource to physicians who are prescribing medications and patients who need on-going support. The Case Manager is instrumental in removing any reimbursement access barriers to treatment for patients, thereby ensuring that they can start on therapy as quickly as possible. The Case Manager thrives 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.

DUTIES AND 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 through conducting the welcome call, reimbursement support, conducting follow up calls, and providing both inbound and outbound call support.
• 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.
• Gather all pertinent and appropriate information from the prescribing physician to complete the necessary forms (private and / or provincial insurance) in a concise, organized and professional manner.
• 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.
• Liaise with PSP team to ensure optimal patient support and communication.
• Maintain ongoing and transparent communication with the patient's healthcare team regarding patient care and reimbursement outcomes as needed. Follow up with patient at a minimum annually to confirm if there have been changes to coverage.
• Diligent record-keeping to ensure continuous care and exceptional customer and 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.
• Perform data entry, answer inbound calls, make outbound calls, manage email, and fax software,

and perform general administrative functions including faxing and filing.

• Must be able to identify and report adverse events to Health Canada (if applicable) and enter source system and third-party systems.
• 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 client and corporate information and discusses same only with appropriate Bayshore personnel.
• Complete other tasks as requested.

Job Qualification

QUALIFICATIONS

• Fluent in both French and English an asset.
• Understanding of provincial and private coverage criteria and how to navigate the Canadian drug coverage landscape.
• Familiarity with the Special Authorization (SA) process for both public and private insurance in assigned territory.
• Experience in the healthcare, pharmaceutical, or insurance industry would be an asset; experience with patients with cancer or rare diseases would also 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 to responding to a patient's emotional, educational, and health literacy needs.
• Proven ability to work autonomously within a team environment, in a remote / virtual setting.
• Strong sense of organization, attention to detail, and ability to multi-task.
• Strong Computer and Technical skills : Excel, Word, Outlook, tablets, webportals / internet use.
• Excellent written and verbal communication and interpersonal skills.
• Established high speed internet access from home office