Jobs
>
Toronto

    Non-Nurse Case Manager, Payor Solutions - Toronto, Canada - Bayshore HealthCare

    Bayshore HealthCare
    Bayshore HealthCare Toronto, Canada

    1 week ago

    Bayshore HealthCare background
    Description

    Job Description

    JOB SUMMARY

    This position will be a single point of contact offering case management support services to plan members. Act as a resource to Pharmacies, and Patient Support Programs and continuous support for plan members for on‐going support with coverage, access to medications, and reimbursement navigation. This position reports into the Program Manager, Payor Solutions.

    Pay rate - $57,000 to $60,000

    DUTIES AND RESPONSIBILITIES

  • Liaise and advocate with insurance companies, Patient Support Programs, physician' offices and healthcare professionals to maximize reimbursement solutions
  • Encourage plan member enrollment in the applicable Patient Support Program
  • Completes and/or reviews Prior Authorization forms prior to submission to insurers, when the plan member is not enrolled within a Patient Support Program
  • Maintain in depth knowledge of public, private, and federal funding mechanisms nationally for all program drugs.
  • Maintain detailed electronic notes in the plan members file
  • Gather all pertinent and appropriate coverage information from the plan member or Patient Support Program to complete pharmacy referrals (Private and/or Public insurance, or financial assistance) in a concise, organized, and professional manner.
  • Proactively offer counseling, advocacy, and assistance for plan members.
  • Act as a central resource liaison for program stakeholders, which include private and public insurers, pharmacies, nurses, and Patient Support Programs.
  • Adjudicate prescriptions to external payers and support Bayshore Pharmacies with troubleshooting any adjudication error or reimbursement issues identified.
  • Communicates with plan members' third-party plans to troubleshoot rejected claims.
  • Coordinate specialty pharmacy services once funding has been secured
  • Provide updates to stakeholders as requested.
  • Potential for large amount of telephone support required.
  • 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

    . Education and/ or Experience

  • Secondary School Diploma.
  • Minimum of 2 years' experience in customer service, in an office or pharmacy setting
  • Experience in the insurance, healthcare, pharmaceutical and Private/Public payers within Canada
  • Strong computer and technical skills: Excel, Word, Outlook
  • Experience in specialty pharmacy workflow with Kroll and NAV software
  • Professional / courteous / efficient telephone manner
  • Proven ability to organize time, set priorities and multi-task to meet various competing work deadlines
  • Candidate must have strong communication and interpersonal skills
  • Ability to work independently and in a team environment
  • Attention to detail
  • Excellent written and verbal communication skills
  • Comfort with investigating and making decisions using sound judgment
  • Familiarity with PIPEDA and how it applies in a confidential plan member environment.
  • Bilingualism, French/English is an asset.

    • "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 individuals purpose, potential and wellbeing."

    Bayshore operates in accordance with the Accessibility for Ontarians with Disabilities Act, and applicable Provincial Human Rights Codes.

  • Bayshore HealthCare

    Program Coordinator, Payor Solutions

    2 days ago

    Bayshore HealthCare Toronto, Canada

    To provide administrative program, and call center support to the Payor Solutions department within Bayshore Specialty Rx. To complete all client referrals, program communications, inputs data and maintains data integrity, and triages all inbound call center inquiries as required ...

  • Bayshore HealthCare

    Program Coordinator, Payor Solutions

    1 week ago

    Bayshore HealthCare Toronto, Canada

    Job Description · JOB SUMMARY · To provide administrative program, and call center support to the Payor Solutions department within Bayshore Specialty Rx. To complete all client referrals, program communications, inputs data and maintains data integrity, and triages all inboun ...

  • Bayshore HealthCare

    Non-Nurse Case Manager, Payor Solutions

    1 day ago

    Bayshore HealthCare Toronto, ON, Canada

    This position will be a single point of contact offering case management support services to plan members. Act as a resource to Pharmacies, and Patient Support Programs and continuous support for plan members for on‐going support with coverage, access to medications, and reimburs ...

  • Bayshore HealthCare

    Non-Nurse Case Manager, Payor Solutions

    1 day ago

    Bayshore HealthCare Toronto, Canada

    This position will be a single point of contact offering case management support services to plan members. Act as a resource to Pharmacies, and Patient Support Programs and continuous support for plan members for on-going support with coverage, access to medications, and reimburs ...

  • TELUS

    Product Manager

    1 week ago

    TELUS Toronto, Canada

    Location: Toronto, ON, CA Moncton, New Brunswick, CA Rimouski, Quebec, CA Quebec, Quebec, CA Montreal, Quebec, CA- Req ID: Jobs by Category: Health- Job Function: Product Management & UX/UI Design- Status: Full Time- Schedule: Regular**Description**: · **Join our team** · **Ready ...

  • BI Canada Ltd

    Medical Science Liaison, Oncology

    3 days ago

    BI Canada Ltd Toronto, Canada

    **The Position**: · Drives scientific dialogue and consensus, establishes awareness and educates about the diseases and assets by developing and maintaining peer-to-peer scientific relationships · Ensures external stakeholders have the necessary knowledge to identify the right pa ...

  • BI Canada Ltd

    Medical Science Liaison

    6 days ago

    BI Canada Ltd Toronto, Canada

    **The Position**: · Drives scientific dialogue and consensus, establishes awareness and educates about the diseases and assets by developing and maintaining peer-to-peer scientific relationships. · Ensures external stakeholders have the necessary knowledge to identify the right p ...

  • Sinai Health

    Clerk - Medical Imaging

    3 days ago

    Sinai Health Toronto, Canada

    Sinai Health is a leading academic health science centre with a provincial, national and international reputation for discovering and delivering life-changing care. Since 2015, we have provided excellent and compassionate care in hospital, community and home. Comprised of Mount S ...

  • Johnson & Johnson

    Bioadvance Access

    1 week ago

    Johnson & Johnson Toronto, Canada

    Janssen-Ortho Inc. is recruiting for an Access & Affordability Manager, BioAdvance, to be located in Toronto, Ontario. · The position is responsible for providing sophisticated support for complex reimbursement issues that are escalated by the BioAdvance Coordinators and/or BioAd ...

  • Green Shield

    Privacy and Compliance Manager

    3 days ago

    Green Shield Toronto, Canada

    **WHO WE ARE** · When it comes to health, we're always looking for ways to push for better. It's why we were founded in the first place. In 1957, our founder, pharmacist William Wilkinson, witnessed a mother sacrifice her health by forgoing her own medicine to pay for her sick da ...

  • Ministry of Children, Community and Social Services

    Case Management Officer

    6 days ago

    Ministry of Children, Community and Social Services Toronto, Canada

    The families we serve are our top priority. We are a fast-paced, high-volume organization that is committed to client-focused service. We are committed to improving the lives of families, better empowering them to plan for the future and achieve economic and social stability. · W ...

  • GSK

    Director of Market Access and Payer Solutions

    5 days ago

    GSK Mississauga, Canada

    **Site Name**: Canada - Ontario - Mississauga · **Posted Date**: Apr · **JOB PURPOSE**: · The Director, Market Access and Payer Solutions role reports directly to the Head of Government Affairs & Market Access (GAMA team). This role is critically accountable to secure (gain, mai ...

  • People Corporation

    Administrator (3 Months Contract)

    3 days ago

    People Corporation Markham, Canada

    We are seeking a Administrator to join our McAteer team in Markham (Onsite). · We are seeking a temporary Administrator who will provide full administrative support to senior executives. The right individual has the ability to demonstrate a standard of excellence, enjoys challeng ...

  • Johnson & Johnson

    Regional Business Manager

    2 weeks ago

    Johnson & Johnson Markham, Canada

    **Biosense Webster Inc. **and **CERENOVUS **, Part of Johnson & Johnson's Families are seeking a Regional Business Manager (RBM) in Canada. · Company overview: Caring for the world, one person at a time, inspires and unites the people of Johnson & Johnson. We welcome innovation—b ...

  • Johnson & Johnson

    National Sales Manager

    2 days ago

    Johnson & Johnson Markham, Canada

    MENTOR a Johnson & Johnson Company, is recruiting for a National Sales Manager in Canada. MENTOR, is a leading supplier of breast implants in the global aesthetic market. The company develops, manufactures, and markets innovative, science-based products for surgical and non-surgi ...

  • McKesson

    Director, Specialty Pharmacy

    6 days ago

    McKesson Mississauga, Canada

    McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you a ...

  • Trillium Health Partners

    Chiropractor - Insight Health Solutions

    5 days ago

    Trillium Health Partners Mississauga, Canada

    **Job Description**: · **Position**:Chiropractor - Insight Health Solutions · **Status**:Temporary Full Time (approx. 12 months) · **File #**: · **Department**:Insight Health Solutions · **Location**: Queensway Health Centre, Bristol Circle Satellite location · **Hours of Work/S ...

  • Trillium Health Partners

    Psychologist - Third Party Mental Health Services

    1 week ago

    Trillium Health Partners Mississauga, Canada

    **Job Description**: · **Trillium Health Partners has an opportunity in our private and third party programs to support clients in their mental health needs.** · **Position**:Psychologist - Third Party Mental Health Service Program · **File #**: · **Job Type**:Temporary Full Tim ...

  • Trillium Health Partners

    Psychologist - Third Party Mental Health Services

    1 week ago

    Trillium Health Partners Mississauga, Canada

    **Job Description**: · **Trillium Health Partners has an opportunity in our private and third party programs to support clients in their mental health needs.** · **Position**:Psychologist - Third Party Mental Health Service Program · **File #**: · **Job Type**: Permanent Part Ti ...

  • Greenshield Holdings

    Ppn Care Coordinator

    15 hours ago

    Greenshield Holdings Mississauga, Canada

    **About Greenshield** · Green Shield is the first integrated health services organization in Canada that is both a payer (offering insurance, administering benefits, and paying claims) and a provider (offering medical, mental health, and pharmacy services). · This evolution also ...