Summary of Position:The Part time Bilingual Nurse Case Manager (CM) is responsible for managing all aspects of the reimbursement environment and program support for assigned physicians in a given geographical area. An expert in regional government payer policies and procedures, the CM supports the regional needs of the client and works directly with the in-house team to facilitate the enrolment, reimbursement, and scheduling process to ensure patients have easy access to their prescribed therapy. The individual also assists the physicians in accessing the needs of each patient resulting in increased patient program enrollment and improved patient outcomes. Accountabilities:
- Customizes program elements to meet the needs of assigned prescribing physicians;
- Reviews patient status and assists the prescribing physician to complete patient enrolment, prepare Special Authorization (SA) petitions for public or private coverage by auditing patient charts, assessing previous therapies and tests in order to complete the SA;
- Proactively assesses programs and makes suggestions to enhance outcomes and quality of service;
- Completes all relevant reports (program specific reports, expenses, etc.) as per specified timelines and as per required standards.
- Welcomes each patient to the program and captures required patient information.
- Provides therapy guidelines to patients and physicians.
- Ensures patient services are coordinated and tracked, according to KPI’s, resulting in expedited access to therapy.
- Coordinates private and public coverage activity directly with insurers following program Standard Operating Procedures.
- Follow up with patient regarding the outcome of reimbursement navigation.
- Provide information and navigate patient through financial assistance.
- Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Associate Program Manager.
- Assists in training and development of new FCM as needed;
- Supports and assists peers through regular and ongoing communication;
- Develops and maintains a positive relationship with the Program Patient Support team;
- Provides timely patient and clinic information as needed, through specific means used by the program.
- Participates in scheduled Key Opinion Leader (KOL) physician meetings with Sales Representatives;
- Develops strong working relationships with physicians and physician office staff, providing additional office support to ensure smooth maintenance of patients enrolled in the program as needed;
- Proactively provides assistance to resolve client issues with regards to assigned physicians;
- Attends scheduled Continuous Medical Education events and reports new activities;
- Provides in service presentation to KOL physicians in collaboration with the Sales Representatives on new program initiatives;
- Acts a liaison and provides ongoing feedback to the Patient Assistance Program based on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance;
- Ongoing maintenance of communication with Program Manager, physicians, physician office staff, client representatives, patients and nursing team as required;
- Completes all relevant reports (time sheets, expenses, mileage, reports etc.) as per specified timelines and as per required standards;
- The Case Manager will also be assigned other duties and tasks as required from time to time;
- Fulfil other duties as required.
- Strong analytical skills including interpretation of regulation and legislation.
- Strong customer service skills.
- Strong business acumen.
- Strong critical thinking skills.
- Ability to communicate effectively both orally and in writing.
- Excellent presentation skills.
- Intermediate knowledge of Microsoft Word, Excel, PowerPoint and other Office Programs.
- Case management experience preferred.
- Registered Nurse or License Registered Nurse license in New Brunswick
- Experience and background in various therapeutic areas is an asset.
- Experience in public or private third-party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support is an asset.
- Background in business administration (pharmaceutical) sales and marketing an asset.
Knowledge of private and public reimbursement structure, systems, and process is an asset.
- Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation is an asset.
- Valid Driver’s License, current auto insurance policy and access to reliable transportation, for regional travel.
- BCLS may be required depending on therapeutic area of program.
About Alio Health Services:
Focused on creating the best experiences for patients, caregivers and the health care industry as a whole. Alio Health specializes in the design and implementation of comprehensive Patient Support Programs (PSP) that enhance the patient's experience throughout their treatment journey. Working with our clients we design customized Programs that connect all parties using a targeted approach, which delivers the simplest and most effective Program focused on the patient's experience.Alio Health’s unique and proprietary PSP workflow automation software and systems ensures excellent quality control and provides significant operational cost efficiencies. This allows Alio to provide in-home services at about the same cost as in-clinic services, thus adding a superior service element to our Patient Support Programs.Together, we are enhancing patient care to positively impact the lives of people everyday.