Bilingual Reimbursement and Nurse Case Manager Remote

at  Bayshore HealthCare

To be a Bilingual Single Point of Contact offering reimbursement support to physicians and medical case management services to patients. Assist the physician with the completion of all program specific paperwork and follow up on submissions pertaining to obtaining drug reimbursement/coverage through private and provincial drug formularies to ensure patients have access to their prescribed treatments in a timely manner. Act as a resource to physicians who are prescribing this medication and continuous support for patients for ongoing telehealth, renewals, and coverage changes.

EDUCATION

• Graduate of Registered Nursing Program or Registered Practical Nursing Program holding current registration from an accredited School of Nursing.
• Up to date CPR/BLS certification
• Specific oncology education (DeSouza certification an asset)
• Ability to work independently and as a part of a team
• Critical thinking and strong clinical judgment

EXPERIENCE

• Reimbursement experience 3+ years
• Measureable experience working in an oncology setting, acute or community care.
• Understanding of provincial and private coverage criteria and how to navigate the Canadian Drug Coverage Landscape.
• Familiarity with the Special Authorization process for both public and private insurance in assigned territory.
• Working knowledge of French language is mandatory.

OTHER SKILLS AND ABILITIES

• Strong Computer and Technical skills: Excel, Word, Outlook, tablets, web portals/internet use
• Excellent verbal communication skills and interpersonal skills
• Established internet and home phone access from home office
• Ability to travel; own vehicle required
  As Canada’s largest and best homecare company, join us as we continue our 50+ year tradition of supporting our Nurses to make “being the difference” a Career!
  Bayshore is committed to a high quality and safe environment for both our staff and clients/patients. Dependent upon Provincial government regulations, and the position being applied for, new hires may be required to provide proof of vaccination against illnesses such as COVID-19, Hepatitis, Seasonal Flu etc. Please speak with the recruiter for Provincial and/or position specific requirements. Medical exemptions or any other kinds of requested exemptions based upon Human Rights Code will be considered on a case-by-case basis.
  “At Bayshore Healthcare, our commitment to Equity, Diversity & Inclusion is our strength. This is how we bring our vision of being the difference in the lives of those we care for, work with and in our communities. We have a great sense of pride in creating a culture of belonging, where individual differences are embraced and celebrated, through programs, resources and policies that support each individuals purpose, potential and wellbeing.”
  Bayshore operates in accordance with the Accessibility for Ontarians with Disabilities Act, and applicable Provincial Human Rights Codes.

• Ensure patient has been enrolled through support program
• Gather all pertinent and appropriate information from the prescribing physician to complete the necessary forms (private and/or provincial insurance) in a concise, organized and professional manner.
• Liaise and advocate with third party providers and provincial governments as necessary to determine coverage options.
• Follow up/advocate until a decision is received, ideally securing coverage for the patient.
• Proactively offer counseling, advocacy and assistance for patients.
• Work closely with the local sales representatives to support specific customer needs.
• Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients and clinics.
• Provide updates to stakeholders as requested.
• Potential for large amount of telephone support required along with occasional travel.
• Participate in ongoing internal and/or external continuing education activities
• Adhere to Bayshore Policies and Procedures
• Report and document Adverse Events as per Pharmacovigilance Requirements;
• Provide telehealth support and telephone follow up to patients at specific intervals as set out in the program SOP or SOW
• Participate in quality activities and continuous improvement initiatives in keeping with the company’s Quality Management System as well as specific performance indicators for the project
• Participate in proactive Health & Safety activities while performing all duties. Is responsible to notify immediate Supervisor of any Health & Safety risks or concerns.
• Maintains confidentiality of client and corporate information and discusses same only with appropriate Bayshore personnel
• Employee will maintain relevant level of knowledge of ICH (International Conference on Harmonization), GCP (Good Clinical Practice) and Health Canada GVP (Good Pharmocovigilance Practices) guidelines appropriate to their hired role which is to be provided at time of hire and annually. With this knowledge the employee will perform the work as required by their assigned function and will be provided with regular updates as required.
• Participate in processes relating to regulatory reporting requirements
• Complete other tasks as requested
  Job Qualification