Job Description

Job Summary:

The Professional Nursing Network RN works with the Nursing Network Team to manage and maintain the subcontracted nursing provider network. Works with the Nursing Network Supervisor to ensure geographic nursing coverage for pharma and payer partners, and independently seeks qualified contractual partners. Manages and conducts credentialing processes for subcontracted providers. Manages the subcontracting process in Salesforce database, follows up on contracting accounts and questions within established parameters; negotiates subcontracted provider rates with agencies using established rate matrix.

Responsible for patient focused programs which may include but is not limited to: collaborating with health care team in providing direction for maintaining high quality patient care, outcomes, and goals for patients; provides enhanced services support and assistance with contractually required Biopharma programs. Follows specific care modules or standard operation procedures approved by the Clinical and Professional Services Team including scripting, assessments, screenings, and education.

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.

External Basic Qualifications

• 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).

Preferred Qualifications

• Bachelor's degree in Nursing (BSN)
• 5 years RN experience
• Home Infusion and/or Home Care RN experience
• Current active Compact Nursing License and single state licenses in all other states.
• Experience working with contracting and contract requirements
• Proven ability to work in a team environment
• Organized and detail oriented with proven problem-solving skills
• Excellent written and 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.
• Knowledge of regulatory policies and accreditation standards
• MS Office Suite Skills

Job Function

Customer Contact Center

Common Location

108 WILMOT ROAD,DEERFIELD,IL,60015-05108-00001-Y

Remote_Posting

Yes

Pay Grade ID

SPECRX-RN

Pay Type

Hourly

Start Rate

33.75

Max Rate

44.75