Summary of Job
Coordinate Home Infusion services that achieve optimal benefit and results from the comprehensive management of members with chronic and/or catastrophic illness, members who are frail elderly and/or members whose illness is complicated by challenging psychosocial conditions. Provide focus on transition activities to benefit clinical needs of members. Combine utilization of medical care and pharmacy, with specific focus on the transition of care needs of members from one setting to another and the inpatient setting (acute, SNF/Rehab) to the home setting to ensure coordination of health care delivery, member education, and preventative intervention. Support the site of care that meets the needs of members at the lowest cost.
Responsibilities
- Provide short term care coordination with members, physician, facilities, and home infusion vendors.
- Assess appropriate site of care utilization and continued medical necessity reviews for prior authorization to vendors.
- Ensure communication with MD offices in relation to Site of Care program.
- Track and contact MD identified as providing scope drug in setting that is at a higher level of care than necessary.
- Assist transfer of members from higher level of care to Home / AIS setting for optimal outcomes.
- Create a Medical Drug dashboard reporting the status of volumes and costs.
- Identify and implement cost saving strategies by shifting the patient site of service.
- Develop, facilitate, and communicate discharge plans in partnership with the member, physician and vendor and at times concurrent review team, case management if applicable, social workers.
- Coordinate services from one setting to another, acute setting to home/Ambulatory Infusion Suites throughout the continuum of care.
Qualifications
- Graduate of an accredited 2–4 year nursing program.
- Active, unrestricted license to practice professional nursing, RN (Preferred) or LPN, in the appropriate state.
- Certification as a Case Manager (Preferred).
- 5 – 10+ years of clinical experience in a managed care setting, preferably including acute care experience (Required).
- Ability to use data analytics to drive decision making and strategy (Preferred).
- Experience leading clinical staff (Preferred).
- Prior case management experience (Preferred).
- Communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required).
- Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required).
- Discharge planning experience (Required).
Additional Information
- Job Type: Standard
- Schedule: Full-time
- Employee Status: Regular
- Requisition ID: 1000002050
- Hiring Range: $72,000-$138,000
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