Field Case Manager (RN/RPN/LPN)

Responsibilities

Customize program elements to meet the needs of assigned prescribing physicians; Review patient status and assist the prescribing physician to complete patient enrolment, prepare payer forms to access public or private coverage by reviewing patient charts, documenting previous therapies and tests; Identify obstacles to obtaining coverage and channel this information to the Program Manager; Develop strong working relationships with physicians and physician office staff, providing additional office support; Proactively provide assistance to resolve issues with regards to assigned physicians; Provide training to physicians and clinics on program and new initiatives; Act as a liaison and provide ongoing feedback to the Program Manager; Complete all relevant reports as per specified timelines and standards; Welcome each patient to the program and capture required patient information; Provide reimbursement payer guidelines to patients and physicians; Ensure patient services are coordinated and tracked according to KPIs; Coordinate private and public coverage activity between patient, physician and insurers; Confirm outcome of reimbursement navigation with the patient; Provide information and navigate patient through financial assistance; Assist patient with pharmacy selection and coordinate drug delivery; Assist patient with coordination of therapy and ongoing therapy status; Refer the patient to contact their healthcare provider for clinical questions outside program materials; Report Adverse Events / Severe Adverse Events following program Standard Operating Procedures; Assist in training and development of new FCM as needed; Support and assist peers through regular and ongoing communication; Develop and maintain a positive relationship with the Patient Support Program team; Provide timely patient and clinic information as needed; Participate in scheduled physician meetings with Pharmaceutical team; Attend scheduled Continuous Medical Education events and report new activities; Provide in service presentation to physicians in collaboration with Pharmaceutical Representatives; Maintain ongoing communication with Program Manager, physicians, office staff, client representatives, patients and nursing team; Complete time sheets, expenses, mileage, reports as required; Be available for standby/on call as part of role.

Requirements

Bachelor’s degree in health care or a related discipline, or a nurse diploma; Minimum five (5) years in the healthcare, pharmaceutical or insurance industry or related experience; Licensed Nurse (RN or RPN/LPN) with active registration from the College of Nurses in the province of employment; Available to travel within an assigned territory, some overnight travel may be required; Valid Driver’s License, current auto insurance policy and access to reliable transportation for regional travel; Knowledge of private and public reimbursement structure, systems, and process; Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation; Strong analytical skills including interpretation of regulation and legislation; Fluency in French and/or English may be required depending on program and geographic location.

Nice to have

Case management experience; Minimum three (3) years nursing experience in a clinic setting; Experience and background in various therapeutic areas; Background in business administration (pharmaceutical) sales and marketing

Benefits

Medical, dental, and vision care; Comprehensive suite of benefits focusing on physical, emotional, financial, and social aspects of wellness; Support for working families (backup dependent care, adoption assistance, infertility coverage, family building support); Behavioral health solutions; Paid parental leave; Paid caregiver leave; Training programs; Professional development resources; Mentorship programs; Employee resource groups; Volunteer activities