Senior Case Manager

About PSPSync

PSPSync is a dynamic and innovative provider of Patient Support Program (PSP) solutions, dedicated to enhancing access, adherence, and outcomes for patients prescribed specialty medications. We collaborate with pharmaceutical manufacturers, healthcare professionals, and pharmacies to streamline the patient journey and ensure seamless care.

Position Overview

The Senior Case Manager (SCM) plays a key role in ensuring exceptional patient support and operational efficiency within PSPSync programs. This role combines high-level case management responsibilities with internal collaboration, leadership support, and quality assurance initiatives.

Key Responsibilities:

• Serve as the first point of contact for internal team escalations
• Participate in monthly file audits, identifying key trends and training opportunities
• Collaborate closely with the Associate Program Manager (APM) on ad hoc PSP initiatives and special projects
• Support management with process improvements, team rollouts, and training efforts
• Assist with data integrity and clean-up initiatives, such as Exception Report management

Patient Support & Case Management:

• Act as the single point of contact for patients enrolled in the support program, and for prescribing physicians where applicable
• Conduct welcome calls to gather information, introduce program services, and obtain required patient consent
• Inform patients about all available program offerings, including reimbursement support, self-injection training, case management, prescription coordination, and compliance monitoring
• Maintain a strong understanding of the Canadian reimbursement landscape and emerging trends
• Liaise with patients, insurers, and physicians to secure the required documentation for optimal reimbursement
• Explore both public and private coverage options to maximize access
• Complete and review insurance paperwork before submission to insurers
• Follow up and advocate with payers until coverage is confirmed
• Conduct financial means assessments and ensure financial assistance renewals are completed on time
• Monitor and complete reimbursement renewals in a timely manner for assigned patient files
• Coordinate with specialty pharmacies and clinics to ensure timely access to treatment
• Support specialty pharmacies with billing coordination as needed
• Manage patient appointment schedules to maximize clinic and homecare efficiency—including scheduling, rescheduling, and collaborating with clinics/nursing teams on staffing challenges
• Communicate appointment details to all relevant internal stakeholders (e.g. pharmacy, clinics, nursing teams)

Quality, Reporting & Compliance:

• Work collaboratively with program leadership and peers to resolve concerns or escalations that may disrupt the patient journey
• Contact patients to support adherence and medication delivery coordination
• Report all Adverse Events (AEs) and Product Quality Complaints (PQCs) immediately upon awareness, as per client requirements
• Maintain accurate, up-to-date patient files and detailed case notes within the CRM database
• Participate in continuous improvement initiatives related to quality, training, and process optimization
• Uphold a high standard of service delivery aligned with KPIs, including call answer rates, reimbursement timelines, AE reporting, and other key program metrics
• Act as a knowledgeable resource to internal and external stakeholders including patients, physicians, nurses, clinics, pharmacies, and the client
• Support data integrity and maintenance efforts as required

Qualifications

• Post-secondary education in healthcare, life sciences, social services, or a related field.
• 2+ years of experience preferred as a Case Manager, Reimbursement Specialist, or Patient Navigator role, preferably in specialty pharmaceuticals.
• Strong knowledge of Canadian private and public reimbursement systems (e.g., RAMQ, ODB, NIHB, etc.).
• Experience in training an asset
• Experience working with CRM platforms (Salesforce, ACCESS CRM, or similar).
• Excellent leadership, communication and interpersonal skills with a patient-centric approach.
• Ability to multitask, prioritize, and jump on wherever needed.
• Proactive, solution-oriented, and skilled at thinking critically
• Bilingual (English/French) is an asset but not required.