[Hiring] Patient Care Navigator @Sentrex

Role Description

The Care Navigator is responsible for managing all the aspects of the enrollment, reimbursement process, and service coordination for patients enrolled into the Patient Support Program (PSP). The Care Navigator will assist physicians/clinics and patients with drug coverage, oversee submissions to private and provincial drug plans, ensure timely access to prescribed therapies, and provide continuous patient support using strong communication and available resources.

A Day in the Life (What you will do here):

• Act as the primary point of contact for all patient related elements of the PSP.
• Responsible for the timely enrollment of the patient into the Patient Support Program.
• Telephone support (including maintenance calls and adherence support both inbound and outbound as needed).
• 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.
• Review the patient status and assist the prescribing physician to prepare documentation for public or private coverage by reviewing patient charts, assessing previous therapies and tests.
• Provide therapy guidelines/education on the program to manage patient and physician expectations.
• Collect information and conduct patient financial assessment eligibility based on program guidelines.
• Liaise with physicians' offices, pharmacies, infusion/injection service providers, and other parties to provide comprehensive and coordinated service to patients and physicians and resolve issues as they arise.
• Ensure patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy.
• Review, analyze, and validate information provided by patients for accuracy and completeness to ensure initiation and continuation of services.
• Maintain service levels in case management, including telephone answer rates, time to initiate contact with the patient, Adverse Events reported as per SOPs, and any other KPIs established at the program level.
• Maintain accurate and timely patient/clinic information within the Customer Relationship Management (CRM) system.
• Foster and promote a spirit of teamwork while working with internal patient support teams. Identify obstacles to obtaining coverage and channel this information to the PSP Supervisor.
• Follow up/advocate until a decision is received, ideally securing coverage for the patient.
• Maintain confidentiality of patient, client, and corporate information and discuss same only with appropriate personnel.
• Additional duties as requested by the Manager.

Qualifications

• Post-secondary education with experience in healthcare is an asset.
• Bilingualism (English and French) is an asset.
• Bilingualism is required in the province of Quebec.
• Experience with reimbursement billing, special access, the appeals process, and providing support and consultation is an asset.
• Knowledge of private and public reimbursement structures, systems, and processes is an asset.
• Must be able to work from home and have a quiet, private home office space.
• Excellent verbal and written communication skills.
• Strong analytical skills including interpretation of regulation and legislation.
• Advanced knowledge of the pharmaceutical distribution industry.
• Excellent customer service, problem-solving, and conflict resolution skills.
• Effective interpersonal skills.

Requirements

• Your commitment to providing a high level of service to your internal and external clients.
• You are highly adaptable with a track record of success during times of growth and organizational change.
• You have a proven track record of developing trust and influence at multiple levels.
• You demonstrate an impactful and candid communication style.
• You have exceptional organizational skills with the ability to build effective working relationships with colleagues, management, and stakeholders.

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.