Cytogenomicist providing case interpretation and oversight at Trillium Health Partners. Collaborating with healthcare professionals in clinical and laboratory genetics.
About the role
- 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
- Employee & Family Assistance Program
- RRSP Matching Program
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