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Reimbursement Nurse Case Manager - Mississauga, ON

Division: Specialty Rx
Job Title: Reimbursement Nurse Case Manager
Job Type: Full-Time
Employment Status: Permanent
Location: Mississauga, ON
Work Area:
Job Category: Nursing
Level: Support
Industry: Healthcare
Company URL: www.bayshore.ca
Years of Experience: 3+
Number of Positions: 1
Languages: English
Date Posted: Apr 07 2014 11:30am
Contact Email: pharmaresumes@bayshore.ca

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.

Job Summary

To provide administrative/program support to physicians and provide case management services to patients. Assist with the completion of paperwork and follow up on submissions pertaining to obtaining drug reimbursement/coverage through private and provincial drug formularies. Provide resources to physicians who are prescribing this medication and support for patients. This position reports into the Program Manager.

Duties and Responsibilities

Ensure patient has been enrolled through the support program.
Review patient charts in physician office (paper and electronic based); keep electronic charts in the company database.
Gather all pertinent and appropriate information and complete the necessary forms in a concise, organized and professional manner.
Follow/advocate for reimbursement until a decision is received.
Provides updates to stakeholders as required.
Counseling, advocacy and assistance for patients.
Works 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.
Potential for large amount of telephone support required along with travel.


Reimbursement experience 3+ years
Knowledge of inflammatory disease; experience in Rheumatology and Dermatology an asset
Understanding of provincial and private coverage criteria and how to navigate Special Authorization process of public and private insurance
Strong Computer skills: Excel, Word, Outlook
Access to internet from home office
Ability to travel; own vehicle required
Work independently; meet deadlines and data collection requirements
Excellent written and verbal communication skills


BScN Degree and Registration with the College of Nurses of Ontario

Other Information

Competitive salary and benefits
Travel reimbursement
Please ensure that you reference the job title in the subject line of your email.

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. To apply, email us at pharmaresumes@bayshore.ca.

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