[Hiring] Oncology Infusion Referral Nurse Sr @Prime Therapeutics

Role Description

Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility. Discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office, and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.). Performs functions under supervision.

Responsibilities

• Provides site of service solutions to patients seeking care at non-preferred treatment sites (e.g., Hospital inpatient or outpatient facilities, non-par cancer treatment centers, etc.).
• Discusses the financial aspect of the specialty drugs to both the member and the ordering physician (or office staff) and to agree to find a lower cost versus higher cost sites of service, coordinating drug infusion at an alternate lower cost treatment site and coordinating concomitant services to support infusion administration in lower cost sites.
• Provides member with resources to optimize their treatment outcomes, by utilizing critical thinking skills and providing specific resources related to their complex illness.
• Actions include supporting member copay-assistance programs, research and coordination to decrease member out of pocket financial responsibility in an office or home setting for drug services.
• Will actively maintain a required case load and the activities to reach overall goals of switching site of service treatment to a lower cost setting while maintaining members' satisfaction during the process.
• Documents and enters data of these cases in web-based application and spreadsheets.
• Supports clinical services such as the appeals program.
• Participates in meetings and consults with management on regular basis to discuss member interaction and program outcomes.
• Maintains appropriate par levels of literature.
• Familiarizes self with community resources available, benefit information or any other information that is valued with the program.
• Maintains an active case load and accurate case records, adhering to all company policies and laws governing patient records including documentation of all daily activities.
• Performs related duties as requested.

Qualifications

• Bachelors - Nursing
• RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
• 5 years of Clinical experience
• Must be eligible to work in the United States without the need for work visa or residency sponsorship

Requirements

• Registered Nurse (RN).
• 5 years of post-degree clinical experience.
• Experience in managed care, specialty drugs, care management and utilization review.
• Meets Credentialing criteria.
• At minimum must have current and active nursing license.
• Ability to apply knowledge in relation to clinical findings from evidence based guidelines.
• Ability to function independently and as a team member.
• Good organizational, time management and communication skills.
• Possesses the ability to achieve organizational goals through development of effective teams.
• Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs.
• Understanding of the clinical aspect of the infusion of those drugs within various sites of service.

Preferred Qualifications

• 5+ years of Oncology Nursing experience
• 5+ years in Oncology Infusion

Benefits

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.