Job Description
Position Type: Full Time
Department:Clinic Solutions
Work Location: Arva, Ontario, Canada
Work Arrangement Clinic based, on-site
Work Hours:Monday to Friday, Standard Business hours EST
Travel Required: No
A proudly Canadian company, Sentrex Health Solutions is a fully integrated specialty distributor and patient support provider for pharmaceutical manufacturers, physicians, and their patients. We provide innovative solutions focused on ensuring patients have access and the support they need to maximize their treatment outcomes. We do this through strategic distribution models and patient support programs that are backed by powerful, integrated technology and experienced, cross-functional teams. Our core capabilities include Specialty Pharmacy Services, Customized Solutions for Warehouse, Wholesale & Distribution, Patient Support Programs, as well as HCP & Clinic Services.
Come and join our team! But first, let us tell you why we love working here:
- We are 100% Canadian with locations across the country
- State-of-the-art facilities to provide high-quality products and services
- The opportunity to be a part of a winning, high-performing team
- Collaborative, engaging workplace culture – we are passionate about our people!
- Flexible working environment that promotes a healthy work-life balance
- Diverse and inclusive culture where your talent and commitment to excellence is welcomed and valued
- High-growth environment that provides opportunities for learning and growth supported by our Employee Development Program and industry-leading, in-house corporate training offered throughout the year
The Opportunity:
At Sentrex, we thrive when our people thrive. We are seeking a Patient Care Navigator - Rheumatology to help patients overcome the administrative and reimbursement barriers that can delay access to specialty rheumatology treatment. As the physician's primary reimbursement and patient-access partner, the PCN has a direct impact on how quickly patients secure coverage, begin prescribed therapy, and maintain continuity of treatment.
As a key member of the Clinic Solutions team, the PCN serves as the primary interface among the rheumatologists and clinic team, external manufacturer-sponsored patient support programs (PSPs), public and private payers, Sentrex Pharmacy, infusion or injection-service providers, and patients or caregivers. The PCN coordinates the access journey from prescription and enrollment through documentation, reimbursement approval, treatment readiness, first dispense or administration, and ongoing renewals, using urgency, sound judgment, empathy, accuracy, and persistent follow-through to resolve barriers and keep every patient moving forward.
A Day in the Life (What you will do here)
Patient Access and Reimbursement Navigation
- Serve as the physician and clinic team's primary reimbursement resource for patients prescribed specialty rheumatology therapies, including biologic and targeted therapies used to treat inflammatory rheumatic diseases.
- Review new prescriptions, referrals, enrollment forms, and supporting clinical information for completeness and immediately identify missing requirements, including documentation of diagnosis, treatment history, prior therapy response, and prescriber-identified baseline requirements needed by the payer or PSP.
- Coordinate timely and accurate patient enrollment with the appropriate external manufacturer-sponsored PSP and confirm that the case has been received and activated.
- Assess and coordinate the most appropriate public or private coverage pathway, including benefits investigation, payer criteria review, coordination of benefits, and coverage sequencing.
- Prepare, review, and coordinate completion of Exceptional Access Program, Special Authorization, prior authorization, insurer, and other reimbursement forms in collaboration with the physician, clinic team, payer, and PSP.
- Draft or coordinate coverage appeals and supporting documentation when required, ensuring submissions clearly address payer criteria, documented treatment history, and identified gaps using clinical rationale provided by the prescriber.
- Coordinate financial assistance, copay support, bridge access, free-goods programs, and other available solutions to minimize avoidable treatment delays and patient financial barriers.
- Maintain end-to-end visibility and accountability for open reimbursement cases, actively follow up on outstanding items, and escalate barriers that could delay coverage, treatment initiation, or continuity of therapy.
Physician, Clinic and PSP Partnership
- Act as the single point of contact for reimbursement-related communication between the rheumatology clinic and external PSPs, creating a clear and efficient workflow for the physician and clinic team.
- Provide proactive, accurate, and actionable patient-status updates to the physician and clinic team, including outstanding documentation, coverage requirements, treatment-readiness items, next steps, risks, and expected timelines.
- Actively manage PSP handoffs and follow-up activity rather than relying on passive status updates; clarify ownership, due dates, and escalation paths for every outstanding action.
- Protect physician and clinic capacity by anticipating documentation requirements, preparing forms, organizing information, tracking authorization renewals, and clearly identifying decisions or signatures required from the clinic.
- Build trusted working relationships with rheumatologists, clinic staff, nurses, PSP case managers, payer contacts, pharmacy teams, infusion providers, and internal partners to support a coordinated patient experience.
- Identify recurring reimbursement barriers, workflow gaps, or service issues and recommend practical improvements that shorten time to treatment, reduce interruptions, and improve clinic satisfaction.
Pharmacy, Infusion and Treatment-Start Coordination
- Partner closely with Sentrex Pharmacy to confirm that prescriptions, coverage approvals, financial assistance, patient consent, and other dispensing requirements are complete and current.
- Coordinate the timing of first and ongoing dispensings and, where applicable, injection training, infusion appointments, and medication delivery with the patient, clinic, PSP, pharmacy, and treatment provider to support the prescribed treatment plan and avoid preventable delays.
- Identify and escalate risks related to coverage, prescription validity, prescriber-identified screening documentation, authorization renewals, dose changes, therapy switches, refill timing, product availability, delivery, patient contact, or other requirements that may affect treatment initiation or continuity.
- Ensure the clinic and patient receive timely communication when an issue may affect treatment start, infusion or injection scheduling, dispensing, or ongoing access, with clear ownership of the actions required to resolve it.
Patient and Caregiver Support
- Serve as an accessible, knowledgeable resource for patients and caregivers with non-clinical questions about enrollment, reimbursement, financial assistance, pharmacy coordination, infusion or injection logistics, and next steps.
- Explain complex reimbursement, pharmacy, and treatment-coordination processes in clear, respectful, and easy-to-understand language, recognizing that patients may be navigating a new diagnosis, disease progression, or treatment change.
- Provide proactive updates so patients understand the status of their case, what is outstanding, and what to expect next.
- Recognize the boundaries of the role, avoid providing clinical advice or interpreting screening results, and promptly direct clinical or medication-related questions to the appropriate healthcare professional.
Case Management, Performance and Compliance
- Document all patient interactions, reimbursement activity, decisions, outstanding actions, treatment-coordination activity, and status changes accurately and promptly in the designated Customer Relationship Management (CRM) or case-management system.
- Manage a high-volume, time-sensitive caseload by prioritizing urgent treatment starts, aging tasks, expiring authorizations, renewal requirements, dose changes or therapy switches, and patients at risk of interruption.
- Meet established service levels and contribute to key performance measures, including enrollment-submission timeliness, time to coverage decision, approval-to-first-dispense or first-administration time, authorization-renewal timeliness, task aging, and documentation accuracy.
- Maintain complete, accurate, and audit-ready records and follow all privacy, confidentiality, consent, quality, and records-management requirements.
- Report Adverse Events, Serious Adverse Events (AEs/SAEs), product complaints, and other reportable information in accordance with Sentrex policies, client requirements, and standard operating procedures.
- Collaborate with Clinic Solutions, Pharmacy, PSP, Operational Excellence, infusion services, and other internal teams to resolve patient-specific issues and improve workflows across the rheumatology patient journey.
- Provide feedback to the Manager on customer needs, payer trends, recurring access barriers, service quality, training opportunities, and operational risks.
- Complete required reports, administrative documentation, and other duties within established timelines and standards.
Key Measures of Success
- Patients progress from prescription and enrollment to coverage and first dispense or administration with minimal avoidable delay.
- Physicians and clinic teams receive timely, accurate, and proactive updates without needing to chase case status.
- Reimbursement submissions are complete, accurate, aligned with payer criteria, and supported by the required treatment-history and clinical documentation the first time whenever possible.
- Outstanding actions across the clinic, PSP, payer, patient, pharmacy, and infusion or injection provider are clearly tracked, actively managed, and escalated when required.
- Patients experience clear communication, coordinated treatment starts, timely authorization renewals, and continuity of access to prescribed therapy.
What you need to ensure you are set up for success:
- Post-secondary education in healthcare, life sciences, pharmacy, business, or a related field, or an equivalent combination of education and relevant experience.
- Two or more years of experience in reimbursement navigation, a patient support program, specialty pharmacy, insurance, clinic coordination, or healthcare case management is preferred.
- Working knowledge of the Canadian public and private drug reimbursement landscape, including Exceptional Access, Special Authorization, prior authorization, coordination of benefits, authorization renewals, and appeal processes.
- Experience working directly with physicians, clinic teams, patients, payers, PSPs, specialty pharmacies, or infusion-service providers.
- Experience in rheumatology or inflammatory arthritis is a strong asset; experience with biologic, targeted, infused, injectable, or other specialty therapies and complex reimbursement pathways is also valued.
- Demonstrated ability to manage a high-volume caseload, competing deadlines, and time-sensitive patient needs with strong organization and consistent follow-through.
- Strong analytical and problem-solving skills, including the ability to interpret payer criteria, identify missing information, and develop practical solutions to access barriers.
- Exceptional attention to detail and ability to complete paper and electronic forms accurately.
- Excellent verbal and written communication skills, with the judgment and empathy required to communicate effectively with physicians, clinic staff, patients, caregivers, and external partners.
- Self-directed and accountable, with the ability to work independently while collaborating effectively across a matrixed team.
- Proficiency with Microsoft Office and experience using CRM, ERP, case-management, or other healthcare technology platforms.
- Knowledge of privacy, confidentiality, pharmacovigilance, and standard operating procedure requirements within a healthcare or pharmaceutical environment.
What makes you a great fit for this team:
- Your commitment to providing a high level of service to your internal and external clients.
- You are highly adaptable with a track record of success during times of growth and organizational change.
- You have a proven track record of developing trust and influence at multiple levels.
- You demonstrate an impactful and candid communication style.
- You have exceptional organizational skills with the ability to build effective working relationships with colleagues, management, and stakeholders.
Why join Sentrex?
We value our employees! Our permanent full-time employees are provided with a:
Sentrex Health Solutions is proud to be an equal opportunity employer demonstrated by our commitment to diversity, inclusion, belonging, equity, and accessibility. We provide a safe space for all team members to express their individuality within our corporate culture.
We encourage you to apply and accept all applications. We realize that not every candidate will meet every single desired qualification. If your experience looks a little different from what we have identified and you think you can bring value to the role, we would love to learn more about you!
Accommodations can be made available upon request for those candidates taking part in the selection process.
Sentrex hiring managers may use artificial intelligence tools to assist them in the recruitment process.
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