Senior Case Manager (SCM)

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Senior Case Manager (SCM) based in Canada (Remote). The Senior Case Manager plays a key role in delivering high-quality patient support services and improving access to specialty medications across Canada. This position combines hands-on patient case management with operational coordination, quality assurance, and internal team support. The successful candidate will guide patients through reimbursement processes, insurance coverage, and financial assistance options while coordinating with healthcare professionals and specialty pharmacies. The role also contributes to team development, process improvements, and data integrity initiatives. Working in a collaborative, patient-focused environment, the Senior Case Manager helps ensure timely access to treatment and continuity of care. This is a full-time, 12-month contract offering the opportunity to make a meaningful impact on patient experiences and program performance. 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.