About This Role
The Case Manager is responsible for overseeing all aspects of patient enrollment, reimbursement, and service coordination for individuals prescribed specific medications. This role involves providing drug coverage support to physicians and patients, ensuring timely access to prescribed treatments, and offering continuous support through effective communication and available resources.
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
- Review the patient status and assist the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests
- Provide therapy guidelines/education on the program to manage patient and physician expectations
- Collect information and conduct patient financial assessment eligibility based on program guidelines
- Ensure patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy
- Report 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 update the Customer Relationship Management (CRM) tool by providing timely patient and clinic information
- Foster and promote a spirit of teamwork while working with internal patient support teams
- Act as a liaison and provide 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
- Identify obstacles to obtaining coverage and channel this information to the Program Manager and/or Assistant Program Manager
- Complete all relevant reports (timesheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards
- Flexibility to work within the operating hours of Monday - Friday, between 8:00am - 8:00pm (EST)
- Additional duties as requested by the Manager
Requirements
- Post secondary education with minimum of 2 years experience in health care
- 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 have:
- 1-2 years of experience in Patient Support Program
- Experience with reimbursement billing, special access, the appeals process, and conducting field-based reimbursement support and consultation
- Knowledge of private and public reimbursement structure, systems, and the process
- Experience with oncology
Benefits
- 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
Important Details
- Schedule: Monday to Friday - 8 hour rotating shifts between 8am - 8pm EST
- Contract: Full-Time, Permanent
About the Company
Sentrex Health Solutions is a proudly Canadian company that is a fully integrated specialty distributor and patient support provider for pharmaceutical manufacturers, physicians, and their patients. They provide innovative solutions focused on ensuring patients have access and the support they need to maximize their treatment outcomes through strategic distribution models and patient support programs. Their core capabilities include Specialty Pharmacy Services, Customized Solutions for Warehouse, Wholesale & Distribution, Patient Support Programs, Strategic Creative Services as well as HCP & Clinic Services.
