Job DescriptionUnder 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
- 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.
- Clinical and Quality oversight for this program is provided by the Manager, Patient Programs.
General Job Information
TitleInfusion Referral Nurse - RN
Job FamilyPharmacy Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date9/23/2019
Date Requisition Created9/23/2019
Work ExperienceClinical, Medical
EducationBachelors: Nursing (Required)
License and Certifications - RequiredRN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
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. Responsible for performing services to support an optimal ( clinical /financial) site of service treatment location such as an independent physician office who provides member drug infusions, or to help locate a lower cost alternative treatment site (e.g. home infusion or infusion center) for drug infusion services versus utilizing the hospital outpatient facility. Role includes discussing financial and clinical considerations with members and their physicians (or office staff) that are receiving or considering care at a higher cost treatment site. Researching available financial programs to decrease members out of pocket expense for the drug services in office. Provide resources to coordinate any aspect of this process, such as locating other qualified providers within the same geographic location. Resource will perform functions under the supervision of the Manager of Medical Pharmacy Solutions, Utilization Management.
- Registered Nurse (RN).
- 5 years of post-degree clinical experience.
- Experience in managed care, specialty drugs, care management and utilization review.
- Meets Magellan 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.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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