Senior Care Navigator providing advanced support for reimbursement needs in Patient Support Programs. Collaborating across various services and ensuring continuity of patient care in Canada.
Responsibilities
Cross-Program Coverage and Continuity
Provide vacation, sick leave, and temporary coverage for Care Navigators across multiple PSPs.
Ensure continuity of patient care during coverage periods, including timely follow-up, documentation, reimbursement activity, and adherence to program-specific KPIs.
Quickly learn and apply different program workflows, escalation pathways, client expectations, and reporting requirements.
Special Projects and Operational Support
Provide dedicated support for special projects across the PSP, including process improvement initiatives, workflow stabilization, program transitions, coverage planning, and operational support as assigned.
Support PSP leadership by identifying process gaps, reimbursement trends, coverage barriers, and opportunities to improve consistency across programs.
Assist with onboarding, knowledge transfer, or temporary workflow support when programs require additional experienced Care Navigator capacity.
Advanced Reimbursement Support
Apply extensive reimbursement expertise across multiple provinces, including public and private payer requirements, provincial coverage criteria, prior authorization processes, appeals, special authorization submissions, and employer or insurer escalations.
Collaborate with patients, insurers, physicians, pharmacies, infusion or injection service providers, and internal PSP teams to resolve reimbursement and access barriers.
Serve as a knowledgeable resource for complex reimbursement scenarios by supporting Care Navigators and PSP leadership with payer-specific requirements and escalation recommendations.
Patient and Program Support
Act as a point of contact for patient-related elements of the PSP when providing assigned coverage or project support.
Support timely patient enrollment, telephone support, maintenance calls, adherence follow-up, and ongoing case management as required by the assigned program.
Review, analyze, and validate patient information for accuracy and completeness to support initiation and continuation of services.
Maintain accurate and timely patient, clinic, and program information within the Customer Relationship Management (CRM) system.
Maintain confidentiality of patient, client, and corporate information and discuss information only with appropriate personnel.
Complete additional duties as requested by the Manager.
Requirements
Post-secondary education in healthcare, life sciences, business administration, or a related field is preferred.
Minimum 3–5 years of direct immunology Patient Support Program experience is required.
Demonstrated experience supporting reimbursement across multiple Canadian provinces is required.
Bilingualism (English and French) is an asset.
Extensive reimbursement experience is required, including private insurance coordination, provincial public coverage, special authorization processes, appeals, payer follow-up, and patient financial assistance pathways.
Advanced knowledge of public and private reimbursement structures, payer systems, documentation requirements, and province-specific reimbursement processes is required.
Ability to rapidly learn and apply program-specific requirements while providing short-term coverage, project support, and operational continuity across different PSPs.
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
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