Nurse Field Case Manager

Shoppers Drug Mart•Winnipeg, MB

2d•CA$80,000 - CA$110,000•Hybrid

About The Position

The Nurse Field Case Manager (FCM) is responsible for a collaborative process of ongoing assessment, planning, facilitation, service coordination, evaluation, and advocacy to meet the needs of the patient/physician/client through flawless customer service. The Nurse Field Case Manager will deliver, through expert communication skills and available resources, quality and cost-effective treatment outcomes for the patient. The Nurse Field Case Manager will work directly with the reimbursement team to help secure drug coverage. They will support physicians in managing all aspects related to facilitating patient access to therapy and will provide service in person or remotely according to customer preference. The Nurse Field Case Manager will help support a busy caseload in their respective territory, building strong working relationships, collaboration, effective communication and attention to detail both internally and externally to meet specific team and business objectives. In addition, the Nurse Field Case Manager will attend training sessions, complete self-learning assignments and independent studies while adhering to SDM Specialty Health Network Standard Operating Procedures, Policies, and the College of Nurses Standards of Practice.

Requirements

Registered Nurse with a current, unrestricted license in the province of employment
Proficient in reimbursement landscape and completion of Special Authorization and Appeal Letters
Demonstrated customer/account focus and consistently deliver on the PSP value proposition
Five or more years direct clinical experience
Strong communication and telephony skills
Demonstrated leadership experience and ability to work under pressure
Ability to provide an organized, efficient approach to case management
Possession of excellent skills in assessment, communication, critical thinking and decision making
Ability to demonstrate understanding of SDM Specialty Health Network policies, legal considerations and professional ethics
Proficiency of computer skills including, Microsoft 365
Ability to adapt to a changing environment
Commitment to the principle of quality client-centered service delivery
Travel required up to 60% in territory (some overnight may be required)
Valid driver’s license and with reliable vehicle

Nice To Haves

BScN preferred, however, a combination of experience and education will be considered
Recent experience with Patient Support Programs (PSP) an asset
Fluently bilingual in both written and spoken languages is an asset (French & English)

Responsibilities

Assist the health care practitioner (HCP) in completing the Program enrolment form, as applicable
Educate the HCP on the Program enrolment requirements
Gather patient Program enrolment required information (physician signature, patient contact information, and product information)
Provide reimbursement assistance to patients and physicians according to need
Provide physicians with payer documentation support
Investigate case-by-case reimbursement options, channels, procedures, and prepares documentation in support of reimbursement requests
Determine patients’ channels and eligibility for reimbursement and provides assistance at all levels
Review patient status and assists the prescribing physician to populate Special Authorization forms (SA) for public or private coverage by reviewing patient charts, assessing previous therapies and test results in order to complete the SA.
Ensure the coordination and follow up of SA submissions with payers
Support treating physician in the development of appeal letters, as required
Act as a resource for treating physicians and provides guidance regarding payer reimbursement criteria
Assist patients and physicians with the annual prescription renewal process
Assist patients and physicians with the SA renewal process (most commonly annually), as applicable
Identify obstacles and delays to obtaining coverage, take appropriate action and identify alternative channels for patient coverage
Management of patient files in the program database
Educate the HCP and patients regarding Program services by providing general Program and Product information based on SOPs, Product Monograph, approved verbatim and other approved materials
Review and discuss comprehensive program components, services and value-add program offerings
Act as a liaison and provide ongoing feedback to manufacturers based on observations in the field and feedback from customers as it pertains to quality of services, training, and other areas of importance.
Collaborate with sales reps and associates according to guidance and guidelines
Attend scheduled educational events as required
Report Adverse Events /Severe Adverse Events (AE/SAEs) in accordance with established agreements
Maintain high standards of professional practice by adhering to the ethics of the profession and keeping abreast of the latest professional advancements
Assume responsibility for personal and professional learning and development
Other responsibilities as required by SDMSHN