Responsible for quality control reviews of ITM investigations at TD, ensuring accuracy and adherence to standards. Collaborating with investigators and QC colleagues for effective error identification and resolution.
About the role
- Bilingual Case Manager managing patient enrollment and reimbursement processes for a pharmaceutical support provider in Canada. Collaborating with patients, insurers, and physicians to facilitate access to treatment.
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.
- Reviews patient status and assists the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests.
- Provides therapy guidelines/education on the program to manage patient and physician expectations.
- Collects information and conducts patient financial assessment eligibility based on program guidelines.
- Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy.
- Reports Adverse Events / Severe Adverse Events (AE / SAEs) following approved SOPs.
- Maintain service levels in case management, including telephone answer rates, time to initial contact with the patient, Adverse Events reported within twenty-four hours of receipt and any other KPIs established as the Program level.
- Electronically updates the Customer Relationship Management (CRM) tool by providing timely patient and clinic information.
- Fosters and promotes a spirit of teamwork while working with internal patient support teams.
- Acts a liaison and provides ongoing feedback to the Program Manager based-on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance.
- Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Assistant Program Manager.
- Completes all relevant reports (time sheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards.
Requirements
- A Bachelor’s degree
- 2-3 years of experience in Patient Support Program
- Bilingualism (English and French) is required
- Experience with reimbursement billing, special access, the appeals process, and conducting field-based reimbursement support and consultation is an asset
- Knowledge of private and public reimbursement structure, systems, and the process is an asset
- Advanced knowledge of the pharmaceutical distribution industry
- Must be able to work from home and have a quiet, private home office space
- Strong analytical skills including interpretation of regulation and legislation
- 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
Benefits
- Competitive Salary and 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
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