The Field Case Manager (FCM) is responsible for managing all aspects of the reimbursement environment and program support for assigned physicians in a given geographical area or hospital. The individual will works directly with the physicians and or the office staff in providing proactive and seamless services with respect to the program by accessing the needs of each MD/office such that the service levels provides a clear differentiating factor compare to other patient support programs. The FCM will complete all necessary forms and paper work related to the support program enrolment and the reimbursement forms and if allowed will do chart audits to gather the necessary information to complete the reimbursement forms. The FCM facilitates the reimbursement process to ensure patients have quick access to their prescribed therapy. Responsibilities: • Customizes current support program elements to meet the needs of assigned top prescribing physicians; adjust based on in clinic or remote MD needs • Reviews patient status and assists the prescribing physician to prepare Special Authorization (SA) petitions for public or private coverage by reviewing patient charts, assessing previous therapies and tests in order to complete the SA. • Provides therapy guidelines to manage physician expectations with respect to reimbursement • Ensures patient services are coordinated and tracked in a timely manner resulting in quick and continued access to therapy • Coordinates all aspects of public and or private coverage activity directly with the provincial formularies and provides support by gathering relevant information for private plans following program Standard Operating Procedures (SOPs). • Works collaboratively with the sales representatives to provide superior services to the customer all the while protecting confidential information • Identifies obstacles to obtaining coverage and channels this information to the District Manager • Proactively assesses programs and makes suggestions to enhance outcomes and quality of service.
Position Requirements: • A Bachelor’s degree or registered nurse (RN) diploma, advanced degree or specific practice management experience preferred. • Normally requires a minimum of four (4) to five (5) years in public or private third party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support, or related experience • Experience with reimbursement billing, special access, appeals process and conducting field-based reimbursement support and consultation. • Strong computer skills. Bilinguism