Registered Nurse (RN) Specialty
Provides enhanced nursing services support, evaluating diagnoses and other clinical criteria to complete requests for prior authorization, specialty care specific to the department and patient needs in an effort to provide exceptional care and support. Administers clinical training and orientation programs and validates and educations subcontracted nursing providers knowledge base. Job Responsibilities:
- Completes initial screening for patients which may include:
- Assists with infusion pump programming and troubleshooting based on Plan of Treatment (POT);
- Completes system driven assessments such as Depression Screenings for select disease states;
- Conducts follow-up assessments and outreach to determine medication history and to improve medication adherence;
- Provides disease state education including medication administration, resources on side effect management, outreached to MDO, etc.
- Responsible for the daily nursing care activities, including completion of nursing coordination/plan of treatment forms, building supply lists, nursing assessments, initial screenings, and surveys for patients, programming and troubleshooting infusion pumps based on the Plan of Treatment (POT) established by a pharmacist, injection site/infusion site education training/techniques, obtaining nursing orders, assay management and patient clinical nursing management, and follow up calls to patients as appropriate per specialty.
- Audits and reports daily on team and individual performance metrics and quality statistics and assist with extrapolation of system applications to develop reports of data from regarding productivity trends.
- Assists in developing, updating, and implementing departmental Standard Operating Procedures related to system applications, programs, processes and merchandise.
- Provides support within the scope of practice for a nurse and escalating to pharmacist for patient specific medication questions, including side effect management and quality of life screening.
- May work with specific nursing specialties such as but not limited to: Infusion Care, Fertility Order, Nursing Network, Care Management.
- May have other responsibilities delegated as specific to nurse specialty and as designated by the specific department, other responsibilities as judgment or necessity dictate.
- Reviews prior authorization criteria for specified payers related to defined medications. Evaluates all requests for prior authorizations, appeals and accompanying tasks.
- Provides nursing network subject matter expert support; administers tracking pharma and payer related nursing documentation request; advises on complex cases and assists in quality care resolution.
- Acts as a liaison between physicians/practitioners, medical consultants and facility clinical staff.
- Participates in professional organizations and workshops to gain additional job related knowledge, in service programs and continuing education as required.
- Serves as Point of Contact for disease-specific operations teams.
- Associate's degree in Nursing
- Current license/registration as an RN (Registered Nurse) with the State Board of Nursing in the state in which the position resides
- Must obtain and maintain Nurse Licensing Compact multi-state license and necessary non-Nursing Licensing Compact state license within 6 months of employment start date (company sponsored); any and all exception to this timeline requires leadership approval
- 2 years' work experience in nursing
- Related work experience in a specialty pharmacy, PBM, and/or healthcare call center setting
- Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner
- Willing to travel up to/at least 10% of the time for business purposes (within state and out of state).
- Bachelor's degree in Nursing
- Active Nursing Licensing Compact multistate license and nursing license(s) in states not participating in Nursing Licensure Compact
- Experience working with contracting and contract requirements if necessary for the appropriate specialty
- Proven ability to work in a team environment
- Organized and detail oriented with proven problem solving skills
- Excellent written/verbal communication skills and interpersonal skills with the ability to lead, motivate, and communicate with internal and external customers
- Knowledge of customer service principles and processing including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction
- Basic skills in MS Office Suite
Salary Range: $33.75 - $44.75 / Hourly
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