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    Nurse Case Manager - Markham, Canada - Bayshore HealthCare

    Bayshore HealthCare
    Bayshore HealthCare Markham, Canada

    1 week ago

    Bayshore HealthCare background
    Home Services / Social Care
    Description
    About the Role

    To be a point of contact offering 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 access through various means to ensure patients have access to their prescribed treatments in a timely manner.

    Act as a resource to physicians who are prescribing this medication and continuous support for patients via phone for renewals, and coverage changes.

    A Day in the Life

    Complete outbound and inbound calls to patients, HCPs, and other key players to support patients through their treatment journey.

    Gather all pertinent and appropriate information from the prescribing physician to complete any necessary forms in a concise, organized, and professional manner.

    Liaise and advocate with client as necessary to determine coverage options.
    Follow-up/advocate until a decision is received.
    Proactively offer counseling, advocacy, and assistance for patients.
    Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, the client, and clinics.
    Ensure ongoing compliance of medication as well as the completion of ongoing symptom support for patients.
    Provide updates to stakeholders as requested.
    Participate in ongoing internal and/or external continuing education activities.
    Adhere to Bayshore Policies and Procedures
    Report and document Adverse Events as per Pharmacovigilance requirements
    Provide telehealth support and telephone follow up to patients at specific intervals as set out in the program SOP or SOW

    Gather all pertinent and appropriate information from the chart to complete the necessary forms (private and/or provincial insurance) in a concise, organized, and professional manner.

    Completes and/or reviews Prior Authorization (PA) or Special Authorization (SA) forms prior to submission to insurers.
    Liaise and advocate with insurance providers and provincial governments as necessary to determine coverage options.
    Proactively offer financial assistance

    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.
    May require travelling on occasion
    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 an accredited School of Nursing.
    Must have a proven track record with excellent customer services skills internally as well as externally.
    Experience working with Patient Support Programs (Required)
    Excellent verbal and written communication skills and interpersonal skills- English & French
    Reimbursement experience (asset)

    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
    Making decisions using sound judgment, 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.
    Ability to travel (as required); own vehicle required.
    Office or home-based depending on geographical location.
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