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Division: | |
Job Title: | Reimbursement Nurse Case Manager |
Job Type: | Full-Time |
Location: | St John, NFLD |
Work Area: | |
Job Category: | Case Management |
Level: | Support |
Industry: | Healthcare |
Company URL: | www.bayshore.ca |
Years of Experience: | 3+ |
Number of Positions: | 1 |
Languages: | English |
Date Posted: | 2/13/2013 |
Contact Email: | bayshore@hirepower.ca |
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Bayshore HealthCare
Bayshore HealthCare is one of the country’s leading providers of home and community health care services and a Canadian-owned company. Its services are purchased by government care programs, insurance companies, workers’ compensation boards, health care organizations, the corporate sector and the public. The Bayshore brand extends across four business divisions: Bayshore Home Health (medical and non-medical home care and staffing services), Bayshore Specialty Rx (specialty pharmacy, infusion and pharmaceutical patient support services), Bayshore Therapy & Rehab (physiotherapy and rehabilitation services) and Bayshore Dialysis (dialysis centers). The company’s goal is to enhance the quality of life, well-being, dignity and independence of Canadians of all ages. Bayshore HealthCare has been a recipient of Canada’s 50 Best Managed Companies award since 2006.
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Job Summary:
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To be a single point of contact offering 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 resource to physicians who are prescribing this medication and continuous support for patients for on-going support, renewals, and coverage changes.
This position reports into the Reimbursement Team Leader.
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Duties and Responsibilities:
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Ensure patient has been enrolled through support program
Review patient charts in physician office (paper and electronic based); keep electronic charts
Gather all pertinent and appropriate information from the chart 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.
Follow-up/advocate until a decision is received, ideally securing coverage for the patient.
Proactively offer counseling, advocacy and assistance for patients.
Work closely with the local sales representatives to support specific customer needs.
Act as a central resource liaison for program stakeholders, which include physicians, nurses, patients and clinics.
Provide updates to stakeholders as requested.
Potential for large amount of telephone support required along with travel.
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Experience:
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Reimbursement experience 3+ years
Measurable experience with patients with Neurological disease states (3 yrs+), specifically Multiple Sclerosis.
Understanding of provincial and private coverage criteria and how to navigate the Canadian Drug Coverage Landscape.
Familiarity with the Special Authorization process for both public and private insurance in assigned territory.
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Education:
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RN, RPN, MS-Specific, Reimbursement Navigation (Public and Private payers) experience
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Other Information:
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Strong Computer and Technical skills: Excel, Word, Outlook, tablets, web-portals/internet use
Established internet and home phone access from home office
Ability to travel; own vehicle required
Ease with working independently, making decisions using sound judgment, and meeting deadlines.
Excellent written and verbal communication skills, data collection requirements
Motivational Interviewing skills/experience an asset.
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How to Apply:
Bayshore is an Equal Opportunity Employer. We encourage all candidates who have the right mix of skills, abilities and a passion for excellence to apply. Please submit your resume through one of the following ways:
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Please state the position applied for in the email subject line.
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