Bilingual Senior Care Navigator – East Coast

This is a fully remote position, open to applicants in Canada.

📋 Description

• Provide coverage and continuity across multiple programs.

• Offer vacation, sick leave, and temporary support for Care Navigators in various Patient Support Programs (PSPs).

• Maintain continuity of patient care during coverage periods, ensuring prompt follow-up, documentation, reimbursement activities, and adherence to program-specific Key Performance Indicators (KPIs).

• Quickly acquire knowledge of diverse program workflows, escalation pathways, client expectations, and reporting requirements.

• Special Projects and Operational Support.

• Deliver dedicated assistance for special projects within the PSP, including process improvement initiatives, workflow stabilization, program transitions, coverage planning, and operational support as needed.

• Aid PSP leadership by pinpointing process gaps, reimbursement trends, coverage challenges, and opportunities to enhance consistency across programs.

• Assist with onboarding, knowledge transfer, or temporary workflow support when programs need additional experienced Care Navigator resources.

• Advanced Reimbursement Support.

• Utilize extensive reimbursement knowledge across various provinces, including public and private payer requirements, provincial coverage criteria, prior authorization protocols, appeals, special authorization submissions, and escalations with employers or insurers.

• Collaborate with patients, insurers, physicians, pharmacies, infusion or injection service providers, and internal PSP teams to address reimbursement and access challenges.

• Serve as a knowledgeable resource for complex reimbursement cases by supporting Care Navigators and PSP leadership with payer-specific requirements and escalation strategies.

• Patient and Program Support.

• Act as a key contact for patient-related aspects of the PSP when executing assigned coverage or project support.

• Facilitate timely patient enrollment, provide telephone support, conduct maintenance calls, perform adherence follow-up, and manage ongoing cases as dictated by the assigned program.

• Review, analyze, and validate patient information for accuracy and completeness to support the initiation and continuation of services.

• Maintain accurate and timely patient, clinic, and program information within the Customer Relationship Management (CRM) system.

• Uphold confidentiality of patient, client, and corporate information, discussing such information solely with appropriate personnel.

• Complete additional tasks as requested by the Manager.

⛳️ Requirements

• Preferred post-secondary education in healthcare, life sciences, business administration, or a related field.

• Required minimum of 3–5 years of direct experience in immunology Patient Support Programs.

• Demonstrated experience with reimbursement across multiple Canadian provinces is a necessity.

• Bilingualism in English and French is an asset.

• Extensive reimbursement experience is required, including coordination with private insurance, provincial public coverage, special authorization processes, appeals, payer follow-up, and patient financial assistance pathways.

• Advanced understanding of public and private reimbursement structures, payer systems, documentation needs, and province-specific reimbursement processes is essential.

• Capability to quickly learn and apply program-specific criteria while providing short-term coverage, project support, and operational continuity across different PSPs.

• Must be able to work remotely and have a quiet, private home office environment.

• Strong verbal and written communication skills are essential.

• Excellent analytical abilities, including the interpretation of regulations and legislation.

• Advanced knowledge of the pharmaceutical distribution industry.

• Outstanding customer service, problem-solving, and conflict resolution skills.

• Effective interpersonal skills are required.

🏝️ Benefits

• Competitive salary and generous vacation benefits.

• Wellness Program, including 5 paid days off for personal well-being!

• Paid sick days.

• Comprehensive benefits package, including dental and extended health benefits, Accidental Death & Dismemberment (AD&D), Long-Term Disability (LTD), and employee/dependent life insurance.

• Employee and Family Assistance Program.

• RRSP Matching Program.