- City: Toronto and GTA
- State/Province: Ontario
- Country: Canada
- Listed: February 25, 2015 11:37 pm
- Expires: This ad has expired
SEND YOUR RESUME TO CAREERS@FLEXMORE.CA or visit us at WWW.FLEXMORE.CA
The Health Services Case Manager is an integral part of the Patient Services team, responsible for the coordination and delivery of services related to the patient support programs offered by our clients Specialty. The role involves interactions with patients, physicians and other health care professionals (HCPs) and members of our client’s multidisciplinary team using web based, telephony and face to face means of communication. The role involves understanding and adherence to corporate, divisional, departmental and program specific standard operating procedures.
• Perform HCP and patient registration activities, according to program protocols and applicable departmental procedures
• Review, analyze and validate information provided by patients and HCPs for accuracy and completeness to ensure initiation of services
• Follow the program protocols to ensure that the most appropriate next step is scheduled to ensure continuity of service delivery to HCPs and patients
• Process data entry activities of pertinent information received at different points of contact during the delivery of program services
• Provide answers to general inquiry calls submitted via telephone or web based platforms on program services, disease state or product related questions, based on information provided as part of the program materials
• Perform surveys on patients and other program users, based on documentation provided and perform data entry activities on information received
• Conduct reimbursement investigations with private and public reimbursement providers
• Participate in reimbursement or other program related research activities, as assigned by the Program Manager and/or Departmental Manager
• Coordinate/facilitate submission of Special Authorization letters to public and private payers
• Conduct reimbursement denial escalations through employers/payers
• Gather information and conduct patient financial assessment eligibility based on program guidelines
• Request financial transactions to be processed based on communicated program guidelines
• Gather pertinent information and coordinate patient’s access to infusion services, as well as conduct follow up activities related to infusion services
• Liaise with physicians’ offices, infusion services providers and other parties to provide comprehensive and coordinated service to patients and physicians
• Receive, record and report Adverse Events, as per program working instructions
• Participate and assist in departmental continuous improvement activities related to process, quality, training, etc.
• Participate in execution and documentation of test plans
• Participate in the development of reports and tools for identifying signals that will flag misunderstanding, misconduct, fraud or other out of protocol program participant related incidents
• Assist with reviews of aggregate data to identify program trends and communicates to Program Manager
• Maintain program data accuracy through review of program documentation for completeness and consistency
• Knowledge of medical terminology, health care environment, reimbursement landscape, therapeutic and product related knowledge
• Understanding and compliance with corporate, divisional, departmental and program specific standard operating procedures
• Community College/CEGEP education OR a recognized trade/technical certification
• More than six months and up to one year in a previous job or jobs
• Required to use menu-driven retrieval and search functions on Windows based applications, web-based applications and proprietary information technology systems; ability to use a switch-based telephony software, etc.
• Use Photocopy, fax machines, printers
• Telephone equipment
• Required to apply standard Company practices. Occasionally some interpretation may be required in selecting the correct approach. Most problems are referred to my supervisor or work team.
Impact of Decisions
• Moderate delays, service inefficiencies or expenses would result from a poor decision; moderate service inefficiencies, cost-savings or new revenue would be generated as a result of a decision that turns out well.
External Customer Service
• Resolve customer complaints
• Solicit business and recommend service options to retail pharmacies, clinics and institutions
• Required to exchange basic information and/or to provide referrals to clients in the case of problems
Other Contacts (Insurance/Public/Private).
• Required to exchange basic information and to resolve problems with external contacts
• Carries out similar tasks or activities within the work group with no management/supervisory responsibilities.
• Manage own time to handle deadlines, peak periods and unexpected situations. Coordination is done with the Team Lead/supervisor and basic information is exchanged with co-workers.
• Expected to suggest innovations to the supervisor which affect the job or its work flow
• Problems and situations to be solved are clearly defined and do not require much interpretation, identified problems are solved by following established procedures, instructions, guidelines or manuals or escalating the problem to Team Leader/supervisor if a solution has not been identified.
Types of Communication:
• Will involve: verbal communication in person or by telephone, bilingualism (were applicable), proofreading documents for errors, completing standard forms, reports, editing or rewriting text.
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