Field Case Manager - British Columbia

PRIMARY DUTIES AND RESPONSIBILITIES:  

Practice Management 

• Customizes program elements to meet the needs of assigned prescribing physicians; 

• Reviews patient status and assists 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; 

• Proactively assesses programs and makes suggestions to enhance outcomes and quality of service; 

• Identifies obstacles to obtaining coverage and channels this information to the Program Manager; 

• 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 issues with regards to assigned physicians; 

• Provides training to physicians and clinics on program and new initiatives approved by the manufacturer; 

• Acts a liaison and provides 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; 

• Reports Adverse Events / Severe Adverse Events following program Standard Operating Procedures; 

• Completes all relevant reports (program specific reports, expenses, etc.) as per specified timelines and as per required standards.  

Patient Support (Based on program design some Field Drug Access Navigator may have limited or no patient interactions)  

• Welcomes each patient to the program and captures required patient information; 

• Provides reimbursement payer 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 the outcome of reimbursement navigation; 

• 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; 

• Mentorship/Peer Support 

• Assists in training and development of new Field Drug Access Navigator as needed; 

• Supports and assists peers through regular and ongoing communication; 

• Develops and maintains a positive relationship with the Patient Support Program team; 

• Provides timely patient and clinic information as needed, through specific means used by the program.  

Manufacturer Interface 

• Participates in scheduled physician meetings with Pharmaceutical team; 

• Attends scheduled Continuous Medical Education events and reports new activities; 

• Provides in service presentation to physicians in collaboration with the Pharmaceutical Representatives on new program initiatives. 

• Other 

• 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 Field Drug Access Navigator will also be assigned other duties and tasks as required from time to time. 

• May be required to be on standby/ on call as part of this role.  

EXPERIENCE AND EDUCATIONAL REQUIREMENTS: 

• A Bachelor’s degree in health care or a related discipline, or a nurse diploma;. Requires a minimum of 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.