Case Manager (Remote)

Sentrex Health Solutions

17h • Remote

About The Position

The Case Manager is responsible for managing all the aspects of the enrollment, reimbursement process, and service coordination for patients who have been prescribed the drug by physicians. The Case Manager will provide drug coverage support to physicians and patients, follow up on submissions pertaining to obtaining coverage through private and provincial drug plans, ensure patients have access to their prescribed treatments in a timely manner, and provide continuous support for patients through excellent communication skills and available resources to ensure patients have easy access to their prescribed therapy.

Requirements

• A Bachelor’s degree
• Excellent verbal and written communication skills in English.
• Strong analytical skills including interpretation of regulation and legislation
• Advanced knowledge of the pharmaceutical distribution industry
• Excellent customer service, problem-solving, and conflict resolution skills
• Effective interpersonal skills
• Typing skills and ability to be a strong functional user of various computer-based programs
• Must be able to work from home and have a quiet, private home office space

Nice To Haves

• Bilingualism (English and French) is an asset
• Experience with reimbursement billing, special access, the appeals process, and conducting field-based reimbursement support and consultation is an asset
• Knowledge of private and public reimbursement structure, systems, and the process is an asset
• Your commitment to providing a high level of service to your internal and external clients.
• You are highly adaptable with a track record of success during times of growth and organizational change.
• You have a proven track record of developing trust and influence at multiple levels.
• You demonstrate an impactful and candid communication style.
• You have exceptional organizational skills with the ability to build effective working relationships with colleagues, management, and stakeholders.

Responsibilities

• Responsible for the timely enrollment of the patient into the Patient Support Program.
• Collaborate with the patient, insurer, and physician regarding the documentation necessary for maximal reimbursement coverage, including the investigation of all public and private insurers and supporting employer escalations as required.
• Reviews the patient status and assists the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests.
• Provides therapy guidelines/education on the program to manage patient and physician expectations.
• Collects information and conducts patient financial assessment eligibility based on program guidelines.
• Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy.
• Reports Adverse Events/Severe Adverse Events (AE/SAEs) following approved SOPs.
• Maintain service levels in case management, including telephone answer rates, time to initiate contact with the patient, Adverse Events reported within twenty-four hours of receipt, and any other KPIs established as the Program level.
• Electronically updates the Customer Relationship Management (CRM) tool by providing timely patient and clinic information.
• Fosters and promotes a spirit of teamwork while working with internal patient support teams.
• Acts a liaison and provides ongoing feedback to the Program Manager based-on observations in the field and feedback from customers as it pertains to the quality of services, training, and other areas of importance.
• Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Assistant Program Manager.
• Completes all relevant reports (timesheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards.
• Additional duties as requested by the Manager.

Benefits

• Competitive Salary and generous vacation entitlement
• Wellness Program (5 paid days off for your well-being!)
• Paid Sick Days
• Competitive Benefits Package including Dental & Extended Health Benefits, AD&D, LTD & Employee/Dependent Life Insurance
• Employee & Family Assistance Program
• RRSP Matching Program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 101-250 employees