Bilingual Nurse Case Manager

at  Calian

Calian PSP, formerly Alio Health, has an exciting opportunity to join our dynamic team! This remote roll offers a competitive salary, health and dental benefits as well as chance to work with a growing company to expand you career experience!
Location
Remote, CAN
The Bilingual Nurse Case Manager (NCM) 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 NCM supports the regional needs of the client and works directly with the 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.
Accountabilities:

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, follow up with Special Authorization (SA) petitions for public or private coverage with prescribing physicians;
• 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 KPl’s, resulting in expedited access to therapy;
• Identifies obstacles to obtaining coverage and channels this information to the Associate Program Manager

Mentorship/Peer Support
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- Assists in training and development of new CM/NCM 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
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- 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;
- 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 the PSP supervisor, physicians, physician office staff, client representatives, patients and nursing team as requires.
- Completes all relevant reports (time sheets, expenses, mileage, reports etc.) as per specified timelines and as per required standards.

Competencies:

• Proven track record of leadership abilities, demonstrating proactiveness in identifying customer needs and ownership in executing solutions;
• Strong communication and interpersonal skills;
• Ability to develop professional relationships effectively with external customers and internal 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 of role while complying with professional and ethical standards of practice;
• Adaptability;
• Computer skills (Word/Excel).

QUALIFICATIONS

• Must be a Nurse (RN, RPN, LPN) in good standing with the respective provincial regulatory body;
• Licensed in more than one province would be an asset;
• English and French bilingualism;
• Case management experience preferred;
• Minimum 2 years of practical clinical experience as a health care professional;
• Experience and background in Multiple Sclerosis is 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;
• Valid Driver’s License, current auto insurance policy and access to reliable transportation, for regional travel;

Please refer the Job description for details