Nurse Case Manager

About the Role

The Nurse Case Manager (NCM) will play an essential role in supporting patients living with a respiratory disease to improve both their health outcomes and quality of life. Complete enrolment calls, respond to patient inquiries and offer reimbursement support to physicians and medical case management services to patients. Assist the Field Nurse Case Manager with the completion of all program-specific paperwork including Special Authorizations, appeals, prescription renewals, and medical clarifications. Follow up on submissions pertaining to obtaining drug reimbursement/coverage through private and provincial drug formularies to ensure patients have access to their prescribed treatments in a timely manner. The Nurse Case Manager will support with scheduling patients and reviewing Post Injection Reports to ensure adequate injection and/or training is completed. Submit Adverse Events as required by Health Canada.

This is a fully remote position that reports under Bayshore Specialty RX located at Mississauga, ON. As a Nurse Case Manager, you will be able to work from anywhere in Canada, including the following provinces: Ontario, Quebec, British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia, New Brunswick, Newfoundland and Labrador, and Prince Edward Island.

A Day in the Life

Assist the Field Nurse Case Manager to complete patient enrolment; including gathering all pertinent and appropriate information to complete the necessary forms (private and/or provincial insurance) in a concise, organized, and professional manner

Liaise and advocate with third-party providers and provincial governments as necessary to determine coverage options

Review patient charts (paper and electronic based); keep electronic charts

Ensure patients are scheduled for blood work and notify physicians of expired blood work results

Complete Welcome Call activities with the patient according to defined scripts

Review Post Injection Reports to confirm next appointment is scheduled and data integrity of the report against the physician order

Track missing Post Injection Reports

Facilitate any required communication with physicians, Patient Support Programs, or other health care professionals involved in the patient’s circle of care

Follow up/advocate until a decision is received, ideally securing coverage for the patient

Work closely with the manufacturer local sales representatives to support specific physician’s and staff needs

Offer and/or provide educational training to patients and physicians on product’s administration

Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics

Coordinate and schedule patients at appropriate injection locations (home, clinic, etc.)

Provide updates to stakeholders based on observations

Ensure patient records are maintained and data-accurate to meet program reporting requirements

Must be able to identify and report Adverse Events to Health Canada, Med Info, and enter into source system and third-party systems

Report and document Adverse Events as per Pharmacovigilance requirements

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

Maintain confidentiality of client and corporate information and discuss same only with appropriate Bayshore personnel

Complete all relevant reports (time sheets, expenses, mileage, reports, etc.) as per specified timelines and Bayshore’s policy

Complete product complaint reports

Adhere to Bayshore and manufacturer Policies and Procedures

Complete other tasks, as requested

What You Bring to the Team

Registered Nurse or Registered Practical Nurse (RN/RPN) license

Preference with candidate that has experience with the product

Registered and in good standing with the College of Nurses

Minimum 2 years’ experience in Patient Support Programs

Providing excellent customer service skills internally as well as externally

Excellent verbal and written communication skills and interpersonal skills; English and French if servicing Quebec and New Brunswick

Reimbursement experience

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

Strong critical thinking and problem-solving skills

Making decisions using sound judgment

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