Job Description

POSITION SUMMARY:

Reporting to the Program Manager, Specialty Services, the Field Case Manager (FCM) is responsible for managing all aspects of the reimbursement environment and program support for assigned physicians in a given geographical area. An expert in regional government payer policies and procedures, the FCM supports the regional needs of the client and works directly with in house team to facilitate the enrolment, reimbursement and scheduling process to ensure patients have easy access to their prescribed therapy. The individual also assists the physicians in accessing the needs of each patient resulting in increased patient program enrollment and improved patient outcomes.

PRIMARY DUTIES AND RESPONSIBILITIES:

Practice Management

• Customizes program elements to meet the needs of assigned prescribing physicians;
• Adherence to College of Nurses standards of nursing practices;
• 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 in order to complete the SA;
• Proactively assesses programs and makes suggestions to enhance outcomes and quality of service;
• Completes all relevant reports (program specific reports, expenses, etc.) as per specified timelines and as per required standards.

Patient Support

• Welcomes each patient to the program and captures required patient information;
• Provides therapy guidelines to patients and 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 patient the outcome of reimbursement navigation;
• Provide information and navigate patient through financial assistance;
• Assist patient with pharmacy selection and coordinate drug delivery;
• Assist patient with coordination of therapy and ongoing patient monitoring;
• Reports Adverse Events / Severe Adverse Events following program Standard Operating Procedures.
• Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Associate Program Manager.

Mentorship/Peer Support

• Assists in training and development of new FCM as needed
• Supports and assists peers through regular and ongoing communication.
• Develops and maintains a positive relationship with the Program Patient Support team.
• Provides timely patient and clinic information as needed, through specific means used by the program.

Client Interface

• Participates in scheduled 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;
• Proactively provides assistance to resolve client issues with regards to assigned physicians;
• Attends scheduled Continuous Medical Education events and reports new activities;
• Provides in service presentation to KOL physicians in collaboration with the Sales Representatives on new program initiatives.
• Provide training to physicians and clinics on program and new initiatives approved by the client.
• 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.
• Ongoing maintenance of communication with Program Manager, physicians, physician office staff, client representatives, patients and nursing team as required

Other

• Completes all relevant reports (time sheets, expenses, mileage, reports etc.) as per specified timelines and as per required standards.
• The Field Case Manager will also be assigned other duties and tasks as required from time to time.
• May be required to be on standby/ on call as part of this role. 

SOMMAIRE DU POSTE:

Relevant du gestionnaire sur le terrain ou gestionnaire principal ou gestionnaire de programme des services spécialisés, le/la gestionnaire de cas ambulant (GCA) est responsable de la gestion de tous les aspects de l'environnement du remboursement et de soutien de programme pour les médecins assignés à une zone géographique donnée. Un expert dans les politiques et procédures de payeur de gouvernement régional, le/la GCA soutient les besoins régionaux du client et travaille directement avec l'équipe interne pour faciliter le processus d'inscription, de remboursement et de planification pour s'assurer que les patients ont un accès facile à leur traitement prescrit. L'individu aide également les médecins à accéder aux besoins de chaque patient, ce qui augmente l'inscription au programme des patients et l'amélioration des résultats pour les patients.

PRINCIPALES FONCTIONS ET RESPONSABILITÉS:

Gestion de la pratique

• Personnalise les éléments de programme pour répondre aux besoins des médecins prescripteurs assignés;
• Passe en revue l'état du patient et aide le médecin prescripteur à compléter le recrutement des patients, préparer des demandes d'autorisation spéciale (AS) pour l'assurance publique ou privée en examinant les dossiers des patients, évaluant les thérapies et des tests précédents afin de compléter l' AS;
• Évalue de manière proactive les programmes et fait des suggestions pour améliorer les résultats et la qualité de service;
• Complète tous les rapports pertinents (rapports spécifiques de programme, dépenses, etc) conformément aux échéanciers spécifiés et selon les normes requises

Soutien aux patients

• Accueille chaque patient au programme et prend en note les informations requises sur le patient;
• Fournit des lignes directrices de traitement aux patients et aux médecins;
• S'assure que les services aux patients sont coordonnés et suivis, selon les indicateurs clés de performance (ICP), résultant en l'accès accéléré à la thérapie;

Mentorat/Soutien des pairs

• Aide à la formation et au développement de nouveaux GCA au besoin
• Soutient et aide les pairs par une communication régulière et continue

Interface client

• Participe à des réunions planifiées des médecins KOL avec les représentants des ventes;
• fait de façon proactive l'aide pour résoudre les problèmes des clients en ce qui concerne aux médecins assignés;
• Assiste aux événements planifiés de formation médicale continue et fait des rapports de nouvelles activités;