Field Nurse Case Manager
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Job Description
Field Nurse Case Manager managing patient enrollment and reimbursement processes for Cencora's healthcare programs. Collaborating with physicians while supporting patients throughout their care and therapy processes.
Responsibilities:
- Customize program elements to meet the needs of assigned prescribing physicians
- Review patient status and assist the prescribing physician to complete patient enrolment, prepare payer forms to access public or private coverage by reviewing patient charts, documenting previous therapies and tests in order to complete the payer forms
- Identify obstacles to obtaining coverage and channel this information to the Program Manager
- Develop 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 provide assistance to resolve issues with regards to assigned physicians
- Provide training to physicians and clinics on program and new initiatives approved by the manufacturer
- Acts as a liaison and provide ongoing feedback to the Program Manager based on observations in the field and feedback from physicians as it pertains to quality of services, training, and other areas of importance
- Complete all relevant reports (program specific reports, expenses, etc.) as per specified timelines and as per required standards
- Welcome each patient to the program and capture required patient information
- Provide reimbursement payer guidelines to patients and physicians
- Ensure patient services are coordinated and tracked, according to KPI’s, resulting in expedited access to therapy
- Coordinate private and public coverage activity between patient, physician and insurers
- Confirm outcome of reimbursement navigation with the patient
- Provide information and navigate patient through financial assistance
- Assist patient with pharmacy selection and coordinate drug delivery
- Assist patient with coordination of therapy and ongoing therapy status
- Refer the patient to contact their healthcare provider should the patient have clinical questions, assessments and situations that fall outside program provided materials or manufacturer product monograph
- Report Adverse Events / Severe Adverse Events following program Standard Operating Procedures
- Assist in training and development of new FCM as needed
- Support and assist peers through regular and ongoing communication
- Develop and maintain a positive relationship with the Patient Support Program team
- Provide timely patient and clinic information as needed, through specific means used by the program.
Requirements:
- A Bachelor’s degree in health care or a related discipline, or a nurse diploma
- Requires a minimum five (5) years, in the healthcare, pharmaceutical or insurance industry or related experience
- Licensed Nurse (RN or RPN/LPN) with active registration from the College of Nurses in the province of employment is required
- Case management experience preferred; minimum three (3) years nursing experience in a clinic setting is an asset
- Available to travel within an assigned territory, some overnight travel may be required
- Valid Driver’s License, current auto insurance policy and access to reliable transportation, for regional travel
- Experience and background in various therapeutic areas is an asset
- Background in business administration (pharmaceutical) sales and marketing an asset
- Knowledge of private and public reimbursement structure, systems, and process
- Experience with reimbursement navigation, special authorization, appeals process and conducting field-based reimbursement support and consultation
- Strong analytical skills including interpretation of regulation and legislation
- Fluency in French and/or English may be required depending on program and geographic location.
Benefits:
- medical, dental, and vision care
- comprehensive suite of benefits focusing on physical, emotional, financial, and social aspects of wellness
- support for working families including backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave
- variety of training programs
- professional development resources
- opportunities to participate in mentorship programs
- employee resource groups
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