Field Nurse Case Manager

Bayshore HealthCare; Mississauga; On-site; CAD 70,000 - 90,000; Full time

Job summary

Bayshore HealthCare is seeking a Field Nurse Case Manager in Mississauga to support patients with respiratory diseases, improve outcomes, and ensure timely drug coverage. You will enrol patients, liaise with physicians and insurers, and maintain accurate records while traveling to physician offices as needed.

The role requires an RN/RPN license, 2+ years in patient support programs, and experience navigating public and private drug formularies across Canada.

Qualifications

• Registered Nurse or Registered Practical Nurse in good standing.
• 2+ years in Patient Support Programs.
• Experience with reimbursement and drug coverage processes.
• Familiarity with provincial/private coverage criteria and PIPEDA.

Responsibilities

• Assist physician with enrolment and paperwork for insurance.
• Advocate with third‑party providers and governments on coverage.
• Maintain patient charts and coordinate tests and renewals.
• Complete adverse event reporting per pharmacovigilance requirements.

Skills

Patient support

Reimbursement knowledge

Communication

Time management

Problem solving

Data accuracy

Driving

Education

RN/RPN license

Tools

Excel

Word

Outlook

Tablets

Web portals

Job description

Job Summary

The Field Nurse Case Manager (FNCM) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. FNCM offers enrolment and reimbursement support to physicians and medical case management services 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.

Duties and Responsibilities

• Assist the prescribing physician to complete patient enrolment; including on‑site visits to the physician office to gather 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 in physician office (paper and electronic based); keep electronic charts.
• 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 product’s administration.
• Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients and clients.
• Provide updates to stakeholders based on observations in the field and physicians.
• Ensure patient records are maintained and data accurate to meet program reporting requirements.
• Ensure timely and compliant reporting of Adverse Events (AEs) and Product Quality Complaints (PQCs) in accordance with Health Canada pharmacovigilance requirements and guidelines, including accurate documentation, appropriate escalation, and effective collaboration with internal stakeholders and regulatory teams.
• 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.
• Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel.
• Requires traveling to physician’s offices on a regular basis as requested by the physician’s office.
• Completes 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

• Registered Nurse or Registered Practical Nurse (RN/RPN) license.
• Preference with candidate that have experience with the product.
• Registered and in good standing with the College of Nurses.
• Minimum 2 years’ experience in Patient Support Programs.
• Providing excellent customer services skills internally as well as externally.
• 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 judgement, and meeting 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 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.
• Valid driver’s license with less than 2 infractions in the past 2 years.

Commitment to Equity, Diversity & Inclusion

At Bayshore Healthcare, our commitment to Equity, Diversity & Inclusion is our strength. This is how we bring our vision of being the difference in the lives of those we care for, work with and in our communities. We have a great sense of pride in creating a culture of belonging, where individual differences are embraced and celebrated, through programs, resources and policies that support each individual's purpose, potential and wellbeing. At Bayshore Healthcare Ltd., and its subsidiaries, we are committed to fostering an inclusive workplace and operate in full compliance with all Provincial and Territorial legislation pertaining to Human Rights Codes and Accessibility requirements. To ensure continued compliance throughout the recruitment and selection process, we encourage candidates to disclose any accommodation needs they may have.