Medical Clinics jobs in Scarborough, ON

RPN – Patient Access & Reimbursement Specialist

Medical Dermatology Practice | North York, Ontario

We are seeking an energetic, highly organized and patient-focused Registered Practical Nurse (RPN) to join our medical dermatology practice in North York.

This is an ideal opportunity for an RPN who is a natural problem-solver, takes initiative and enjoys getting things done. You will work closely with four dermatology specialists and our clinical team to help patients successfully navigate access to advanced therapies for complex dermatological conditions.

This is a hybrid clinical and patient-access role. The position combines hands-on clinical nursing with patient navigation and reimbursement support, providing an opportunity to remain actively involved in patient care while developing specialized expertise in access to advanced therapies.

You do not need to be an expert in reimbursement or advanced dermatology therapeutics to be successful in this role. We can teach the reimbursement processes, drug access pathways and treatment-specific knowledge to the right candidate.

What we cannot easily teach is drive, judgment, organization, curiosity and the ability to move a case forward.

The Opportunity

The RPN – Patient Access & Reimbursement Specialist plays an important role in helping patients gain timely access to physician-prescribed advanced therapies, including biologics and biosimilars.

You will manage cases from initial prescription through coverage investigation, authorization and ongoing follow-up. You will communicate with patients, physicians, pharmacies, drug manufacturers, public and private insurers and other stakeholders to identify barriers and find solutions.

The expected role distribution is approximately 30% clinical nursing and 70% patient navigation and reimbursement. The clinical component will keep you actively involved in patient care, while the larger patient-access component will focus on helping patients successfully navigate coverage and gain access to advanced therapeutic medications.

This is a hands-on, fast-moving role for someone who enjoys variety, can prioritize competing demands and is comfortable picking up the phone, investigating a problem and seeing it through to resolution.

Key Responsibilities

Clinical Nursing – Approximately 30%

• Provide hands-on nursing care within a specialized medical dermatology practice.
• Support dermatologists and the clinical team with patient assessments, nursing care and clinical follow-up as appropriate to the practice.
• Participate in patient education and provide clear, compassionate communication regarding treatment and care.
• Support patients receiving or preparing to receive advanced therapies.
• Recognize and appropriately escalate clinical concerns to the dermatologists or other members of the clinical team.
• Maintain accurate and timely clinical documentation.
• Develop familiarity with complex dermatological conditions and advanced therapeutic medications through hands-on experience and ongoing training

Patient Navigation & Reimbursement - approximately 70 %

• Manage patient cases requiring access to advanced therapies for medical dermatological conditions.
• Coordinate the end-to-end patient access and reimbursement process, including benefits investigation, prior authorization, coverage submissions, follow-up and appeals where required.
• Communicate directly with patients regarding coverage, documentation requirements, treatment access and next steps.
• Liaise with private insurers, Ontario public drug programs, pharmacies, manufacturers and patient support programs.
• Work closely with the dermatologists and clinical team to ensure required clinical and administrative information is complete and submitted appropriately.
• Identify reimbursement or access barriers quickly and take ownership of finding a solution.
• Maintain accurate, timely and well-organized patient documentation.
• Use TELUS Kroll and PS Suite to document patient information, process and track cases, and support efficient workflow.
• Monitor outstanding cases and follow up proactively rather than waiting for issues to resolve themselves.
• Develop and maintain working knowledge of Ontario drug coverage programs, including ODB and the Trillium Drug Program, as well as private payer requirements.
• Learn and apply knowledge of advanced therapies and their associated access pathways across medical dermatology.
• Contribute to a positive, collaborative and highly efficient practice environment.

What We Are Looking For

• Current RPN registration in good standing in Ontario.
• Strong clinical judgment and an ability to understand and communicate medical information.
• Excellent verbal and written communication skills.
• Strong organizational skills and exceptional attention to detail.
• Ability to manage multiple active cases and competing priorities without losing track of details.
• Comfortable working independently while collaborating closely with physicians and the broader clinical team.
• Strong computer skills and the ability to learn new systems and processes quickly.
• A genuine commitment to patient service and advocacy.

Experience That Is an Asset — But Can Be Taught

Experience with any of the following would be an advantage:

• Patient reimbursement or patient access programs
• Private insurance benefits investigation and prior authorization
• Ontario public drug programs, including ODB and Trillium
• Biologics and biosimilars
• Medical dermatology
• Autoimmune or inflammatory disease
• TELUS Kroll and/or PS Suite
• Specialty pharmacy or pharmaceutical patient support programs

The right RPN does not need to arrive with all of this knowledge. We are prepared to provide training to someone who demonstrates the aptitude, initiative and work ethic to learn it quickly.

The Person We Are Looking For

We are looking for someone with energy and initiative — someone who sees a problem and thinks, “I'll figure it out.”

You are likely someone who:

• Moves quickly and works with a sense of purpose.
• Is resourceful and doesn't need to be told what to do next.
• Enjoys solving problems and navigating complicated situations.
• Can handle a busy day without becoming overwhelmed.
• Takes ownership of patient concerns from beginning to end.
• Is confident speaking with patients, physicians, pharmacies and insurance representatives.
• Is comfortable picking up the phone and getting answers.
• Pays close attention to details while still seeing the bigger picture.
• Learns quickly and is genuinely curious.
• Is dependable, accountable and willing to pitch in wherever needed.
• Brings a positive, energetic attitude to the workplace.

In short, we are looking for an RPN with some spark — someone who is bright, motivated, personable and ready to make things happen.

Why This Role?

This is an opportunity to become an integral member of a specialized medical dermatology practice and develop expertise in an increasingly important area of patient care: access to advanced therapies.

You will work directly with four experienced dermatology specialists and gain valuable knowledge of complex dermatological conditions, advanced therapeutics and the Ontario healthcare and reimbursement landscape — while continuing to use your nursing skills in a meaningful clinical capacity.

If you are an RPN who enjoys people, patient care, problem-solving, pace and having a tangible impact on access to treatment, we would like to hear from you.

Please submit your resume and a brief cover letter explaining why this role interests you.

Job Type: Full-time

Pay: $75,000.00-$79,000.00 per year

Ability to commute/relocate:

• Toronto, ON M5N 1A8: reliably commute or plan to relocate before starting work (required)

Application question(s):

• Technical Proficiency:

Working knowledge with the TELUS Kroll system is an advantage.
Proficiency in the PS Suite EMR system is preferred.

Experience:

• healthcare administration and reimbursement specialization : 1 year (required)

Language:

• English (required)
• Clearly communicate in writing and verbally in English (required)

Licence/Certification:

• Registered Practical Nurse (required)

Location:

• Toronto, ON M5N 1A8 (required)

Work Location: In person