Care Navigator role assisting LifestyleRx patients to access and benefit from healthcare services. Focused on guiding patients and ensuring they are informed and supported throughout their care journey.
About the role
- Care Navigator managing patient support and drug reimbursement processes for Sentrex Health Solutions. Collaborating with patients and physicians to ensure timely access to therapies.
Responsibilities
- Act as the primary point of contact for all patient related elements of the PSP.
- Responsible for the timely enrollment of the patient into the Patient Support Program.
- Telephone support (including maintenance calls and adherence support both inbound and outbound as needed).
- 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 the 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.
- Liaise with physicians’ offices, pharmacies, infusion/injection services providers and other parties to provide comprehensive and coordinated service to patients and physicians and resolve issues as they arise.
- Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy.
- Review, analyze and validate information provided by patients for accuracy and completeness to ensure initiation and continuation of services.
- Maintain service levels in case management, including telephone answer rates, time to initiate contact with the patient, Adverse Events reported as per SOPs, and any other KPIs established as the Program level.
- Maintains accurate and timely patient/clinic information within the Customer Relationship Management (CRM) system.
- Fosters and promotes a spirit of teamwork while working with internal patient support teams.
- Identifies obstacles to obtaining coverage and channels this information to the PSP Supervisor.
- Follow‐up/advocate until a decision is received, ideally securing coverage for the patient.
- Maintains confidentiality of patient, client and corporate information and discusses same only with appropriate personnel.
- Additional duties as requested by the Manager.
Requirements
- Post secondary education with experience in healthcare is an asset
- Bilingualism (English and French) is an asset.
- Experience with reimbursement billing, special access, the appeals process, and providing support and consultation is an asset
- Knowledge of private and public reimbursement structure, systems, and the process is an asset
- Must be able to work from home and have a quiet, private home office space
- Excellent verbal and written communication skills
- Strong analytical skills including interpretation of regulation and legislation
- Advanced knowledge of the pharmaceutical distribution industry
- Excellent customer service, problem-solving, and conflict resolution skills
- Effective interpersonal skills
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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