Nurse Case Manager

Job Title: Nurse Case Manager Department: Patient Support ProgramsLocation: Remote Travel: 0%Calian Manager: Program Manager Education: College or UniversityLevel: Junior, Intermediate, Senior Status: Full-Time or Part-TimeSummary of Position:The Nurse Case Manager (NCM) is responsible for managing all aspects of thereimbursement environment and program support for assigned physicians in eachgeographical area. An expert in regional government payer policies and procedures, the NCMsupports the regional needs of the client and works directly with the in-house team tofacilitate the enrolment, reimbursement, and scheduling process to ensure patients haveeasy access to their prescribed therapy. The individual also assists the physicians inassessing the needs of each patient resulting in increased patient program enrollment andimproved patient outcomesAccountabilities • Customizes program elements to meet the needs of assigned prescribing physicians. • Reviews patient status and assists the prescribing physician to complete patient enrolment, prepare Special Authorization (SA) petitions for public or private coverage by auditing patient charts, assessing previous therapies and tests to complete the SA. • Completes all relevant reports (program specific reports, expenses, etc.) as per specified timelines and as per required standards • Welcomes each patient to the program and captures required patient information. • Provides therapy guidelines for patients and physicians. Proactively helps resolve client issues with regards to assigned physicians. • Ensures patient services are coordinated and tracked, according to KPI’s, resulting in expedited access to therapy. • Coordinates private and public coverage activity directly with insurers following program Standard Operating Procedures. • Follow up with patients regarding the outcome of reimbursement navigation.• Provide information and navigate patient through financial assistance. • Identifies obstacles to obtaining coverage and channels this information to the Associate Program Manager • Participate in scheduled Key Opinion Leader (KOL) physician meetings with Sales Representatives. • Develops strong working relationships with physicians and physician office staff, providing additional office support to ensure smooth maintenance of patients enrolled in the program as needed. • Provides service presentation to KOL physicians in collaboration with the Sales Representatives on new program initiatives. • Acts a liaison and provides ongoing feedback to the Patient Assistance Program based on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance. • Maintain ongoing communication with Program Manager, physicians, physician office staff, client representatives, patients and nursing team as requires.Competencies:• Proven track record of leadership abilities, demonstrating proactiveness inidentifying customer needs and ownership in executing solutions.• Strong communication and interpersonal skills.• Ability to develop professional relationships effectively with external customers andinternal associates.• Organizational skills that demonstrate ability to prioritize and manage deliverables,and to effectively navigate within a matrix organization.• Ability to establish and encourage patient autonomy.• Ability to manage challenging patient situations with empathy and patience.• Ability to understand and apply medical and/or business knowledge to all aspects ofrole while complying with professional and ethical standards of practice.• Computer skills (Word/Excel).Qualifications Level Junior: • College or university degree in nursing. • Holds a current and active nursing license in good standing. • Advanced English. • 1 year of case management experience preferred. • Minimum 2 years of practical clinical experience as a health care professional. • Experience and background in various therapeutic areas are an asset. • Experience in public or private third-party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support is an asset. • Background in business administration (pharmaceutical), sales and marketing an asset. • Knowledge of private and public reimbursement structure, systems, and process is an asset. • Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation is an asset;Qualifications Level Intermediate:• College or university degree in nursing.• Holds a current and active nursing license in good standing.• Advanced English.• 1-2 years of case management experience preferred.• 2-3 years of practical clinical experience as a health care professional.• Experience and background in various therapeutic areas are an asset.• Experience in public or private third-party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support is an asset. • Background in business administration (pharmaceutical), sales and marketing an asset. • Knowledge of private and public reimbursement structure, systems, and process is an asset. • Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation is an asset;Qualifications Level Senior:• College or university degree in nursing.• Holds a current and active nursing license in good standing with applicable province• Advanced English.• 2+ years of case management experience preferred.• 3+ years of practical clinical experience as a health care professional.• Experience and background in various therapeutic areas are an asset.• Experience in public or private third-party reimbursement arena or pharmaceuticalindustry in sales, managed care, or clinical support is an asset.• Background in business administration (pharmaceutical), sales and marketing anasset.• Knowledge of private and public reimbursement structure, systems, and process is anasset.• Experience with reimbursement navigation, special authorization, appeals processand conducting field-based reimbursement support and consultation is an asset;Working Conditions and / or Job Requirements:• Must possess mobility to use standard office equipment, including a computer (finitemovements such as typing), telephoning and other office functions.• Requires mental stamina to maintain attention to detail despite interruptions, and vision to read printed materials and a computer screen.Direct Reports:• None