Senior Case Manager (SCM)

Accountabilities: Serve as the primary point of contact for patients enrolled in support programs and prescribing physicians, where applicable. Conduct welcome calls, collect relevant patient information, obtain consent, and explain available program services, including reimbursement assistance, self-injection training, prescription coordination, and adherence monitoring. Guide patients through public and private reimbursement pathways, including coverage assessments, insurance documentation, financial assistance applications, and renewal processes. Liaise with patients, insurers, physicians, specialty pharmacies, clinics, and nursing teams to secure documentation, resolve coverage issues, and coordinate timely treatment access. Follow up with payers and advocate on behalf of patients until reimbursement and coverage are confirmed. Coordinate patient appointments, including scheduling and rescheduling, while collaborating with clinics and nursing teams to address operational or staffing challenges. Support specialty pharmacies with billing coordination and facilitate medication delivery and adherence follow-ups. Act as the first point of contact for internal escalations, helping resolve concerns that could disrupt the patient journey. Collaborate with program leadership on special projects, process improvements, training initiatives, team rollouts, and operational priorities. Participate in monthly patient file audits, identify trends and training opportunities, and contribute to data integrity and exception report management. Maintain accurate patient records and detailed case notes in the CRM system, ensuring documentation is complete and up to date. Report adverse events and product quality complaints immediately upon awareness, following applicable program requirements. Monitor service delivery against key performance indicators, including call answer rates, reimbursement timelines, reporting obligations, and other quality standards. Act as a knowledgeable resource for internal and external stakeholders while contributing to continuous improvement, quality assurance, and compliance initiatives. Requirements: Post-secondary education in healthcare, life sciences, social services, or a related field. At least two years of experience preferred in case management, reimbursement support, patient navigation, or a similar role, ideally within specialty pharmaceuticals or patient support programs. Strong understanding of Canadian public and private reimbursement systems, including programs such as RAMQ, ODB, and NIHB. Experience navigating insurance coverage, reimbursement documentation, financial assistance programs, and patient support processes. Familiarity with CRM platforms such as Salesforce, ACCESS CRM, or comparable systems. Strong communication, interpersonal, and relationship-building skills, with a compassionate and patient-centered approach. Demonstrated ability to manage competing priorities, multitask effectively, and adapt to changing operational needs. Excellent critical-thinking, problem-solving, and organizational skills, with a proactive and solutions-oriented mindset. Ability to collaborate effectively with patients, healthcare professionals, pharmacies, clinics, insurers, and internal teams. Experience supporting training, quality assurance, file audits, or process improvement initiatives is an asset. Bilingual proficiency in English and French is an asset but not required. A strong commitment to accurate documentation, confidentiality, compliance, and high standards of patient service. Benefits: Salary: $60,000–$70,000 annually. Contract duration: 12 months. Employment type: Full-time contract. Work arrangement: Remote, based in Canada. Professional impact: Opportunity to improve patient access to specialty medications and support continuity of care. Career development: Exposure to patient support program operations, reimbursement processes, quality assurance, training, and continuous improvement. Collaborative environment: Opportunity to work closely with healthcare professionals, specialty pharmacies, clinics, and program leadership. Additional benefits, such as healthcare coverage, paid time off, bonuses, or equipment allowances, are not specified in the available job description.