Nurses In Insurance Jobs in New Tecumseth, ON (NOW HIRING)

JOB SUMMARY
Nurse Case Manager (NCM) will play an essential role in supporting patients living with a neurological/rare disease to improve both their health outcomes and quality of life. NCM offers enrolment and 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 key resource to physicians who are prescribing this medication and continuous support for renewals, and coverage changes. In addition to these responsibilities, the role may require occasional travel for offsite meetings within Canada, approximately two to three times per year, as well as travel to physicians' offices alongside the client's Key Account Manager upon request.
DUTIES AND RESPONSIBILITIES
Assist in completing patient enrolment; including gathering all pertinent and appropriate information 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.
Ensure patients are scheduled for necessary diagnostic tests and notify physicians of any expired test results that require follow-ups.
Complete Welcome Call activities with the patient according to defined scripts.
Provide patients and physicians with direct toll-free number.
Review post visit reports to confirm next appointment is scheduled and data integrity of the report against the physician order, if applicable.
Track missing post visit reports, if applicable.
Facilitate any required communication with physicians, Patient Support Programs, or other health care professionals involved in the patient's circle of care.
Follow up and advocate until a decision is received, ideally securing coverage for the patient, if applicable.
Work closely with the manufacturer local sales representatives to support specific physician's and staff needs, if applicable.
Offer and/or provide educational training to patients and physicians on product(s).
Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients, and clinics.
Coordinate and schedule patients at appropriate visit locations (home, clinic, etc.), if applicable.
Provide updates to internal and external stakeholders based on observations.
Ensure patient records are maintained and data-accurate to meet program reporting requirements.
Ensure timely and compliant reporting of Adverse Events (AEs) and Product Quality Complaints (PQCs) in accordance with Health Canada pharmacovigilance requirements and guidelines, including accurate documentation, appropriate escalation, and effective collaboration with internal stakeholders and regulatory teams.
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.
Maintain confidentiality of pharmaceutical partner(s) and corporate information and discuss same only with appropriate Bayshore personnel.
Complete all relevant reports (time sheets, expenses, mileage, reports, etc.) as per specified timelines and Bayshore's policy, if applicable.
Complete product complaint reports.
Adhere to Bayshore and manufacturer Policies and Procedures.
Complete other tasks, as requested
OTHER SKILLS AND ABILITIES
Some traveling required. 

QUALIFICATIONS
Education
Graduate of registered Nursing Program or registered practical nursing program holding current registration from a provincial licensing body in Canada.
Experience 
Registered and in good standing with their provincial regulatory body.
Minimum 2 years' experience in Patient Support Programs or equivalent. 
Demonstrated expertise in delivering exceptional customer service and fostering positive relationships with internal and external stakeholders.
This position requires bilingual proficiency in French and English (spoken and written) due to operational, client, and regulatory requirements.
Understanding of provincial and private coverage criteria, Special Authorization processes and how to navigate the Canadian drug coverage landscape is an asset.
Strong computer and technical skills: Excel, Word, Outlook, tablets, web portals/internet use.
Strong critical thinking and problem-solving skills.
Making decisions using sound judgment.
Proficient with accurate data collection and data integrity. 
Ease with working in a paperless environment.
Ability to drive for results.
Proven ability to work in a team environment.
Ability to resolve conflict in a professional matter.
Strong sense of organization and attention to detail.
Self-regulation of time management and the ability to multi-task and adhere to deadlines.
Familiarity with PIPEDA and how it applies in a confidential patient environment.
Ability to work in a quiet working environment with proven ability to work autonomously within a remote/virtual team environment.
Established high speed internet access from home office