Nurse Case Manager

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

Job summary

A leading healthcare provider is seeking a Nurse Case Manager to support patients with reimbursement and medical case management services. The role involves liaising with physicians, managing patient records, and ensuring timely access to treatments. Ideal candidates will have a nursing background, experience in patient support, and strong communication skills. This position offers the opportunity to make a significant impact on patient care within a collaborative team environment.

Qualifications

• Registered and in good standing with a provincial regulatory body.
• Minimum 2 years’ experience in Patient Support Programs or similar roles.
• Fluency in English and French (if applicable).

Responsibilities

• Assist in completing patient enrollment and liaise with third-party providers.
• Review and maintain patient charts, ensuring timely follow-ups.
• Provide educational training on product administration to patients and physicians.

Skills

Customer Service

Stakeholder Relationship Management

Critical Thinking

Problem Solving

Data Collection

Multitasking

Education

Graduate of a Registered Nursing Program or Licensed Practical Nursing Program

Tools

Excel

Word

Outlook

Job description

JOB SUMMARY
The Nurse Case Manager (NCM) plays a vital role in supporting patients with reimbursement support for physicians and medical case management services. They assist physicians with program-specific paperwork and follow-up on submissions related to drug reimbursement/coverage through private and provincial formularies, ensuring timely access to prescribed treatments. The NCM also acts as a resource for physicians prescribing medication and provides ongoing support for patients, including renewals and coverage updates.

DUTIES AND RESPONSIBILITIES

1. Assist in completing patient enrollment by gathering pertinent information for forms (private and/or provincial insurance) in a professional manner.
2. Liaise with third-party providers and provincial governments to determine coverage options.
3. Review and maintain patient charts (paper and electronic).
4. Ensure scheduling of diagnostic tests and notify physicians of expired test results requiring follow-up.
5. Conduct Welcome Calls with patients using defined scripts.
6. Review Post Injection Reports to confirm next appointments and data accuracy.
7. Track missing Post Injection Reports.
8. Communicate with physicians, Patient Support Programs, and healthcare professionals involved in patient care.
9. Follow up to secure coverage decisions for patients.
10. Collaborate with manufacturer sales representatives to support physician and staff needs.
11. Provide educational training on product administration to patients and physicians.
12. Serve as a liaison for program stakeholders, including physicians, nurses, patients, and clinics.
13. Coordinate patient injection appointments at appropriate locations.
14. Update stakeholders based on observations and maintain accurate patient records.
15. Identify and report Adverse Events to Health Canada and other systems per pharmacovigilance requirements.
16. Participate in quality improvement activities and adhere to the company's policies and procedures.
17. Maintain confidentiality of all client and corporate information.
18. Complete all reports and documentation accurately and timely.
19. Perform other tasks as assigned.

QUALIFICATIONS

Education

• Graduate of a Registered Nursing Program or Licensed Practical Nursing Program with current registration in Canada.

Experience

• Registered and in good standing with a provincial regulatory body.
• Minimum 2 years’ experience in Patient Support Programs or similar roles.
• Exceptional customer service skills and stakeholder relationship management.
• Fluency in English and French (if applicable).
• Knowledge of provincial and private drug coverage criteria and authorization processes.
• Strong computer skills: Excel, Word, Outlook, web portals.
• Critical thinking, problem-solving, and decision-making skills.
• Accurate data collection and management skills.
• Ability to work in a paperless, remote environment with high-speed internet.
• Teamwork, conflict resolution, organization, and multitasking abilities.
• Understanding of PIPEDA and confidentiality requirements.