About the role
Job Summary The Case Manager (CM) is expert point of contact offering case management support services to patients and physicians. The CM will assist the patients, physicians, and nurses with the completion of all program-specific paperwork. The CM will act as a resource to physicians who are prescribing medications and patients who need on-going support. They are instrumental in removing any reimbursement access barriers to treatment for patients, thereby ensuring that they can start on therapy as quickly as possible. They thrive in an environment that emphasizes teamwork and accountability, possesses a deep willingness to serve customers, and drives positive customer experiences in a fast‐paced work environment while showing flexibility to adapt to competing demands across the portfolio as required.
Duties And Responsibilities
- Ensure patient has been enrolled in the patient support program (PSP). Set the tone for a warm welcome into the program.
- Provide direct telephone assistance to patients requiring reimbursement support.
- Provide patients and physicians with direct toll-free number.
- Develop strong relationships with patients, caregivers, and their healthcare team by infusing confidence, trust, security, and relief.
- Facilitate a patient’s access to a particular medication by offering reimbursement navigation services.
- Investigate reimbursement options available to the patient and maximize the patient’s coverage via private and public payers, while minimizing the financial assistance offered through the PSP and/or out-of-pocket expenses for the patient.
- Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
- Coordinate with pharmacy drug coverage and dispensing. Troubleshoot any filling/billing issues as required
- Liaise with PSP team to ensure optimal patient support and communication, if applicable.
- Maintain ongoing and transparent communication with the patient’s healthcare team.
- Diligent record-keeping to ensure continuous care and exceptional customer and patient experience.
- Uncover and proactively identify gaps and opportunities for improvement in patient experience.
- Through patient-oriented solutions, manage challenging patient situations with empathy and patience.
- Work with the site representatives to support specific customer needs.
- Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.
- Provide updates to internal and external stakeholders as requested and required.
- Perform data entry, answer inbound calls, make outbound calls, manage e-mail and fax software, and perform general administrative functions including faxing and filing.
- Must be able to identify and report Adverse Events to Health Canada and enter into source system and third-party systems, as applicable
- Report and document adverse events as per pharmacovigilance requirements.
- 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 pharmaceutical partner(s) and corporate information and discusses same only with appropriate Bayshore personnel.
- Complete other tasks as requested.
Qualifications
- Completion of post-secondary education or equivalent.
- Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset
- Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders
- Must be fluent in verbal and written communication and interpersonal skills for both English and French
- Experience in the healthcare, pharmaceutical, or insurance industry would be an asset
- Strong customer service, communication, problem-solving and interpersonal skills required.
- Demonstrates sensitivity and commitment to utilizing a patient-centric approach; is adept to responding to a patient’s emotional, educational, and health literacy needs
- Making decisions using sound judgment, and meeting deadlines.
- Ease of working in a paperless environment.
- Mindful of accuracy and thoroughness of data entry for reporting requirements.
- Strong sense of organization, attention to detail, and ability to multi-task.
- Excellent written and verbal communication and interpersonal skills.
- Strong computer and technical skills: Excel, Word, Outlook, tablets, web portals/internet use
- Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
- Established high speed internet access from home office.
- Flexibility to adapt and learn multiple programs based on demand.
Primary Location ON-Mississauga
About Bayshore HealthCare
At Bayshore, we believe in creating special moments for our clients each and every day, whether at the bedside, on the phone or in the clinic. These moments touch the lives of our clients and our employees, and they guide the way we run our business. These moments inspire, change and encourage us. They are what we call the Bayshore difference.
Bayshore HealthCare is one of the country’s leading providers of home and community health care services and is a Canadian-owned company.
With over 100 locations across the country, including home care offices, pharmacies and infusion clinics, Bayshore has more than 13,000 staff members and provides care to over 350,000 clients. We are dedicated to enhancing the quality of life, dignity and independence of all Canadians, by providing customized care plans and solutions that allow clients to remain in the comfort of their own home. See what some of our clients have to say about their experience with Bayshore. We have been a recipient of Canada’s Best Managed Companies award since 2006.
Chez Bayshore, nous croyons en la création de moments spéciaux pour nos clients, chaque jour, que ce soit à leur chevet, au téléphone ou dans une clinique. Nous cherchons à améliorer la qualité de vie, la dignité et l’autonomie de tous les Canadiens, en fournissant des plans de soins personnalisés et des solutions qui permettent à nos clients de rester dans le confort de leur propre foyer.
Bayshore, une entreprise exclusivement canadienne, est l’un des plus importants fournisseurs de services de santé à domicile et en milieu communautaire au Canada. Avec plus de 100 établissements à travers le pays, y compris des succursales dédiées à la prestation de soins à domicile, des pharmacies et des cliniques de perfusion, Bayshore compte au-delà de 13 000 employés et prodigue des soins à plus de 350 000 clients.
AP-2000672
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About the role
Job Summary The Case Manager (CM) is expert point of contact offering case management support services to patients and physicians. The CM will assist the patients, physicians, and nurses with the completion of all program-specific paperwork. The CM will act as a resource to physicians who are prescribing medications and patients who need on-going support. They are instrumental in removing any reimbursement access barriers to treatment for patients, thereby ensuring that they can start on therapy as quickly as possible. They thrive in an environment that emphasizes teamwork and accountability, possesses a deep willingness to serve customers, and drives positive customer experiences in a fast‐paced work environment while showing flexibility to adapt to competing demands across the portfolio as required.
Duties And Responsibilities
- Ensure patient has been enrolled in the patient support program (PSP). Set the tone for a warm welcome into the program.
- Provide direct telephone assistance to patients requiring reimbursement support.
- Provide patients and physicians with direct toll-free number.
- Develop strong relationships with patients, caregivers, and their healthcare team by infusing confidence, trust, security, and relief.
- Facilitate a patient’s access to a particular medication by offering reimbursement navigation services.
- Investigate reimbursement options available to the patient and maximize the patient’s coverage via private and public payers, while minimizing the financial assistance offered through the PSP and/or out-of-pocket expenses for the patient.
- Represent the patient with private or public insurers to optimize drug coverage and assist with the completion of Special Authorization (SA) and/or Prior Authorization (PA) forms, when applicable.
- Coordinate with pharmacy drug coverage and dispensing. Troubleshoot any filling/billing issues as required
- Liaise with PSP team to ensure optimal patient support and communication, if applicable.
- Maintain ongoing and transparent communication with the patient’s healthcare team.
- Diligent record-keeping to ensure continuous care and exceptional customer and patient experience.
- Uncover and proactively identify gaps and opportunities for improvement in patient experience.
- Through patient-oriented solutions, manage challenging patient situations with empathy and patience.
- Work with the site representatives to support specific customer needs.
- Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.
- Provide updates to internal and external stakeholders as requested and required.
- Perform data entry, answer inbound calls, make outbound calls, manage e-mail and fax software, and perform general administrative functions including faxing and filing.
- Must be able to identify and report Adverse Events to Health Canada and enter into source system and third-party systems, as applicable
- Report and document adverse events as per pharmacovigilance requirements.
- 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 pharmaceutical partner(s) and corporate information and discusses same only with appropriate Bayshore personnel.
- Complete other tasks as requested.
Qualifications
- Completion of post-secondary education or equivalent.
- Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset
- Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders
- Must be fluent in verbal and written communication and interpersonal skills for both English and French
- Experience in the healthcare, pharmaceutical, or insurance industry would be an asset
- Strong customer service, communication, problem-solving and interpersonal skills required.
- Demonstrates sensitivity and commitment to utilizing a patient-centric approach; is adept to responding to a patient’s emotional, educational, and health literacy needs
- Making decisions using sound judgment, and meeting deadlines.
- Ease of working in a paperless environment.
- Mindful of accuracy and thoroughness of data entry for reporting requirements.
- Strong sense of organization, attention to detail, and ability to multi-task.
- Excellent written and verbal communication and interpersonal skills.
- Strong computer and technical skills: Excel, Word, Outlook, tablets, web portals/internet use
- Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment
- Established high speed internet access from home office.
- Flexibility to adapt and learn multiple programs based on demand.
Primary Location ON-Mississauga
About Bayshore HealthCare
At Bayshore, we believe in creating special moments for our clients each and every day, whether at the bedside, on the phone or in the clinic. These moments touch the lives of our clients and our employees, and they guide the way we run our business. These moments inspire, change and encourage us. They are what we call the Bayshore difference.
Bayshore HealthCare is one of the country’s leading providers of home and community health care services and is a Canadian-owned company.
With over 100 locations across the country, including home care offices, pharmacies and infusion clinics, Bayshore has more than 13,000 staff members and provides care to over 350,000 clients. We are dedicated to enhancing the quality of life, dignity and independence of all Canadians, by providing customized care plans and solutions that allow clients to remain in the comfort of their own home. See what some of our clients have to say about their experience with Bayshore. We have been a recipient of Canada’s Best Managed Companies award since 2006.
Chez Bayshore, nous croyons en la création de moments spéciaux pour nos clients, chaque jour, que ce soit à leur chevet, au téléphone ou dans une clinique. Nous cherchons à améliorer la qualité de vie, la dignité et l’autonomie de tous les Canadiens, en fournissant des plans de soins personnalisés et des solutions qui permettent à nos clients de rester dans le confort de leur propre foyer.
Bayshore, une entreprise exclusivement canadienne, est l’un des plus importants fournisseurs de services de santé à domicile et en milieu communautaire au Canada. Avec plus de 100 établissements à travers le pays, y compris des succursales dédiées à la prestation de soins à domicile, des pharmacies et des cliniques de perfusion, Bayshore compte au-delà de 13 000 employés et prodigue des soins à plus de 350 000 clients.
AP-2000672