Senior Case Manager
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Job Description
Senior Case Manager managing Patient Support Programs at Sentrex Health Solutions. Delivering case management, training, and support services to ensure patient access to treatments.
Responsibilities:
- Responsible for the timely enrollment of the patient into the Patient Support Program
- Collaborate with the patient, insurer and physician regarding the documentation necessary for maximal reimbursement coverage, including the investigation of all public and private insurers and supporting employer escalations as required
- Reviews patient status and assists the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests
- Provides therapy guidelines/education on the program to manage patient and physician expectations
- Collects information and conducts patient financial assessment eligibility based on program guidelines
- Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy
- Reports Adverse Events / Severe Adverse Events (AE / SAEs) following approved SOPs
- Maintain service levels in case management, including telephone answer rates, time to initial contact with the patient, Adverse Events reported within twenty-four hours of receipt and any other KPIs established as the Program level
- Electronically updates the Customer Relationship Management (CRM) tool by providing timely patient and clinic information
- Fosters and promotes a spirit of teamwork while working with internal patient support teams
- Acts a liaison and provides ongoing feedback to the Associate Program Manager based-on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance
- Provides back-up assistance to PSP Supervisors, Associate Program Managers and Programs Managers when required
- Identifies obstacles to obtaining coverage and channels this information to the Program Manager and/or Associate Program Manager
- Recommends corrective actions to ensure deliverables are met
- Collaborates and participates in PSP team and client meetings as necessary
- Ensures access to therapy has been expedited determined by effective coordination and tracking, according to Program KPIs
- Completes all relevant reports (time sheets, expenses, mileage, validate CRM reports, etc.) as per specified timelines and as per required standards
- Responsible for the creation of work-instructions and training documents as required by the program
- Aids with program pre and post launch-activities
- Update and revise training content based on ongoing business needs
- Deliver training content and facilitate learning sessions in person and virtually while using a variety of methods
- Manage multiple projects with tight deadlines while providing valuable input to enhance and customize processes that exceed operational needs
- Be a subject matter expert as it relates to the CRM and Case Management for Patient Programs at Sentrex Health Solutions
- Shadowing of case managers to provide training and support as needed
- Provide ad-hoc support to multiple programs, teams, and departments
- Assists with data clean-up as required
- Provide additional support with other duties or projects as requested by PSP Management
Requirements:
- Bachelor’s Degree or College Diploma in a relevant field of study
- 2-5 years of experience in Patient Support Programs with advanced knowledge of Case Management and the pharmaceutical distribution industry
- Demonstrates an aptitude for continuous learning
- Advanced knowledge of reimbursement billing, special access, the appeals process, and conducting field-based reimbursement support and consultation is required
- Must be able to work from home and have a quiet, private home office space
- Excellent verbal and written communication skills in English
- Knowledge of private and public reimbursement structure, systems, and the process is required
- Strong analytical skills including interpretation of regulation and legislation
- Excellent customer service, problem-solving, and conflict resolution skills
- Strong interpersonal skills
- Strong functional user of various computer-based programs
- Bilingualism (English and French) is an asset
- Proficiency in Adobe Acrobat, SharePoint, and Microsoft Office applications is required
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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