Hybrid Senior Case Manager, Pharmacy

at Sentrex Health Solutions

• Job title: Senior Case Manager, Pharmacy
• Job type: Full Time
• Experience level: Senior
• Salary: CA$56,000 - CA$67,000 per year
• Degree requirement: Professional Certificate
• Location requirements: Hybrid, Markham, Canada

About the role

• Pharmacy Senior Case Manager responsible for ensuring workflow in Ophthalmology clinics. Collaborating with healthcare providers and managing patient access to medications to maximize treatment outcomes.

Responsibilities

• Creates the patient profiles (pharmacy)
• Ensures the EF are complete - sends to the PSP (PSP creates Luminav profile)
• Calls patient to welcome them into the program
• Serve as a patient advocate by collaborating with healthcare providers and insurance companies to ensure access to appropriate medications and minimize out-of-pocket expenses
• Assist with SA completion and facilitate the submission of SA to the Insurance provider
• Assist with the reconciliation of Free doses
• Conducts Test bills
• Reports Adverse Events / Severe Adverse Events (AE / SAEs) following approved SOPs
• Provides daily oversight to ensure that prescription workflow for designated One Team clinics is completed in a timely manner and according to clinic specifications
• Acts as the main point of contact to answer questions related to designated clinics from clinic, field and pharmacy staff while appropriately escalating concerns to the management team (Supervisor or a Program Manager)
• Assists with Pharmacy Assistant duties and responsibilities including prescription entry/labelling/packaging, preparing shipping reports, following up on insurance billing issues, answering phones, scanning/filing of paperwork and arranging courier deliveries as required
• Adherence to all relevant guidelines including the established Standard Operation procedures and all applicable regulatory requirements as set out by the applicable provincial pharmacy college
• Attends and participates in staff meetings
• Collaborate with the pharmacy, PSP (Case Manager), clinic and patient regarding the documentation necessary for maximum reimbursement coverage
• Perform other duties as assigned by manager

Requirements

• Post secondary diploma from Pharmacy Assistant program an asset
• Previous work experience in a pharmacy setting a strong asset
• Willingness to work in-person at the pharmacy
• Proficiency with Kroll strongly preferred
• Strong computer skills in Windows environments and MS Office (Excel, Word)
• Strong verbal and written communication skills required
• Ability to communicate in other languages an asset
• Knowledge and understanding of specialty medications along with third-party billing issues an asset
• Highly organized with strong attention to detail
• Excellent communication and interpersonal skills to effectively collaborate with patients and healthcare professionals
• Ability to prioritize, organize, and manage a caseload of patients efficiently
• Knowledge of insurance plans, formularies, and prior authorization processes
• Familiarity with pharmacy software systems and electronic health records
• Commitment to maintaining patient confidentiality and adhering to ethical standards in healthcare

Benefits

• Competitive Salary and generous vacation entitlement
• Wellness Program (5 paid days off for your well-being!)
• Paid Sick Days
• Competitive Benefits Package including Dental & Extended Health Benefits, AD&D, LTD & Employee/Dependent Life Insurance
• Employee & Family Assistance Program
• RRSP Matching Program