To be a 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 on-going telehealth, renewals, and coverage changes.
This position reports to the Pharmaceutical Program Manager or Team Leader
DUTIES AND RESPONSIBILITIES
- 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
- Complete other tasks as requested
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
- 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.
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
- Must be bilingual (French/English)