Drug Reimbursement Specialist- Algoma District Cancer Program- Part Time

Purpose of Position:

The Drug Reimbursement Specialist evaluates, facilitates and coordinates access to medication assistance for oncology patients. This coordination will occur in consultation with the Systemic Therapy Program Team including Medical Oncologists, Pharmacists, Pharmacy Technicians, Nurses and Social Workers.

An essential component of the role will be to collaborate with government, community based and private agencies that provide financial assistance for medications and to serve as an advisor to patients, families and health care providers regarding medication access to facilitate the process of treatment with each individual either within the centre or within their local community.

The specialist provides a centralized resource within the Algoma District Cancer Program to coordinate the submission of Section 8 applications, by securing funds from the Ministry of Health and Long term Care, and/or private Insurance Companies and Third-party insurance providers, compassionate use, as well as ‘special access.’

Duties and Responsibilities:

Client Care

Interview patients and families to complete a needs assessment for financial assistance for medications not covered by OHIP or Cancer Care Ontario’s New Drug Funding Program.
Act as a liaison and referral source between patients, families, and hospital and community resources related to medication access.
Confirm status of medication approval process and communication with appropriate stakeholders.
Engage patients and families in problem-solving to develop long-term strategies for medication reimbursement throughout the treatment process.
Work with physicians to coordinate transmission of EAP requests to Ontario Drug Benefit Exception Access program.
Track status of special funding requests, coordinate submission of additional information when required and communicate with patients when request approvals are received.
Receive, edit, and submit supporting documents with drug applications to approve parties in a timely manner.
Track and monitor status of applications within a database and with assigned parties.
Communicate with patients and staff of the developing status of applications.
Coordinate with Internal and External Stakeholders.
Consult with appropriate programs to facilitate and improve ongoing coordination of financial coverage of medications.
Await and retrieve application outcomes from assigned parties in a timely manner. Notify staff and patients of approvals or denials. Assist with appeal process if warranted. Identifies Ontario Drug Benefit criteria indicators with each patient and or determine means of funding with patient.
Notify and educate patient of the reimbursement process. Assist oncology nurses with coordinating the delivery of the treatment (provide prescription and approval to pharmacy; provide Physicians orders to the nursing services for the administrations of the medication).
Facilitate renewal process to extend funding for the continuation of therapy.
Provide relevant data for patient case files.
Work closely with Supportive Care to obtain assistance for patients and provide reimbursement guidance with respects to private insurance claims and co-payment assistance programs.

Administration

Maintain updated knowledge of the reimbursement challenges and changes in Ontario Drug Benefit Formulary.
Develop and maintain a data base to track patients, medication issues and outcomes of interventions, in order to provide ongoing monitoring and evaluation of the outcomes of programs/services.
Recommend policies and procedures for effective access to medication coverage.
Consult with appropriate programs to facilitate and improve ongoing coordination of financial coverage of medications.
Other duties as assigned.

Quality Assurance and Outcome Measurement

Expedite weekly quality assurance audits and correspond with designated party for resolution.
Provide quarterly statistics to management.
Collect data and monitor trends for decision making in order to make program improvements.

Staffing and Licensing Requirements:

Bachelor’s degree in related field and/or post-secondary degree OR diploma
Three years work experience within related field

Knowledge and Skills:

Ability to work effectively and efficiently as a team member in a fast paced environment in stressful situations.
Customer service, interpersonal and telephone skills.
Computer literacy in a Microsoft environment.
Ability to maintain successful working relationships with the interdisciplinary team to achieve positive patient outcomes.
Ability to organize time effectively to perform the duties of the position.
Ability to meet and interact with people in a pleasant, professional, responsible and reassuring manner.
Behaviour consistent with Hospital Mission, Values and Standards of Performance.
Human relations skills including empathy, sensitivity, understanding of human and organizational behavior, motivational techniques and counseling skills (e.g. teaching patients).
Ability to read, write and communicate to perform the duties of the position.

Present and or contributes to various department meetings with current polices, procedures and new developments.
Ability to navigate the internet and experience workings with online forms
Provide reimbursement education for ADCP and pharmacy staff.
Provide recommendations of the position and reimbursement process to ensure continual improvement of the process.
Attend educational in-services.
Knowledge of Cancer Care Ontario New Drug Funding Program guidelines, policies and procedures an asset.
Knowledge of the Ontario Drug Benefit formulary an asset.
Knowledge of the Pharmaceutical Industry an asset.
Ability to develop and compile statistical reporting in order to maintain a monthly log of patients requiring reimbursement assistance and the success rates.
Advanced organizational skill in order to prioritize duties.
Research skills to search for information on various grants and programs available.

All new employees shall be fully vaccinated against COVID 19-prior to their start date. For clarity, fully vaccinated means that 14 days have elapsed after completion of your vaccine series (i.e. full two doses). The Hospital’s Occupational Health team will require evidence of full vaccination prior to an employee’s start date. If not fully vaccinated, the Hospital’s Occupational Health team can assist successful applicants with setting up the necessary appointments to become fully vaccinated, but any start date may be delayed to the date on which a successful applicant becomes fully vaccinated. The hospital’s requirement that successful applicants be fully vaccinated is subject to any accommodation obligations it may have under the Human Rights Code. Employees shall also be required to obtain boosters or other vaccinations related to COVID-19, as deemed necessary by the Hospital, and any failure to do so will be considered willful misconduct and/or disobedience and will result in the termination of the Employee’s employment without notice or pay in lieu thereof.

Sault Area Hospital is a respectful, caring, and inclusive workplace. We are committed to championing accessibility, diversity, equal opportunity and maintaining a barrier-free selection process for job applicants. Requests for accommodation can be made at any stage of the recruitment process providing the applicant has met the requirements for the open position. Applicants need to make their requirements known to the Human Resources department when contacted. All requests are handled confidentially.

This position is covered by a collective agreement. Applications from outside the bargaining unit are welcome, but can only be considered if the position is not filled from within the bargaining unit.