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Field Case Manager (RN or RPN) - GTA in Toronto / GTA at Innomar Strategies

Date Posted: 9/21/2018

Job Snapshot

Job Description

POSITION SUMMARY:
 
Reporting to the Field Manager or Senior Manager or 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;
  • Reviews patient status and assists the prescribing physician to complete patient enrolment, prepare Special Authorization (SA) petitions for public or private coverage by reviewing 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;
Mentorship/Peer Support
  • Assists in training and development of new FCM as needed
  • Supports and assists peers through regular and ongoing communication.
Client Interface
  • Participates in scheduled KOL physician meetings with Sales Representatives;
  • 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.
  • The Field Case Manager will also be assigned other duties and tasks as required from time to time.

Job Requirements

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
  • RN or RPN , Registration with the Provincial College of Nurses; case management experience preferred;
  • Available to travel within an assigned territory, some overnight travel may be required;
  • Valid Driver’s License, current auto insurance policy and access to reliable transportation, for regional travel;
  • Experience and background in various therapeutic areas is an asset;
  • Normally requires a minimum of three (3) to five (5) years in public or private third party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support,
  • Background in business administration (pharmaceutical) sales and marketing an asset;
  • Knowledge of private and public reimbursement structure, systems, and process;
  • Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation;
  • Strong analytical skills including interpretation of regulation and legislation;
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
  • Knowledge of pharmaceutical distribution industry
  • Strong customer service skills
  • Strong business acumen
  • Strong analytical and mathematical skills
  • Strong critical thinking skills
  • Ability to communicate effectively both orally and in writing
  • Effective interpersonal and leadership skills
  • Effective organizational skills; attention to detail
  • Ability to consistently meet deadlines
  • Excellent problem-solving skills; ability to resolve issues effectively and efficiently
  • Excellent presentation skills
  • Intermediate knowledge of Microsoft Word, Excel, PowerPoint and other Office Programs