High Cost Therapy Liaison RN

At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal. Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being. Our dedication to promoting children's health extends beyond our organization and encompasses the broader community.

About the role

The High Cost Therapy Liaison RN is responsible for submitting accurate and timely medication authorizations. This includes communication with insurance providers, manufacturers, and clinical teams to assist with managing the authorization process of high-cost drugs. Serve as a subject matter expert for high-cost therapies to provide knowledge on insurance and FDA requirements provided at CHST to clinicians and departments. This role requires a strong analytical mind and attention to detail to navigate the complex regulations surrounding drug authorization and reimbursement.

Responsibilities

• Collaborate with various staff within the provider network and health services team to obtain prior authorization and submission of appeals for high-cost therapies.
• Provide guidance and support to patients in navigating the authorization and approval process.
• Develop and maintain relationships with pharmaceutical manufacturers to ensure timely authorization and administration of medication therapies.
• Collaborate with other healthcare teams and departments to ensure all applicable steps have occurred to administer the High-Cost Therapies.
• Stay up to date with regulations and policies related to High-Cost Therapies.
• Assist with coordination of Peer to Peers and Appeals when indicated.
• Utilize payor portals to identify medical policies and authorization submission requirements.
• Assist with effective problem-solving or general assistance to the Medication Authorization Coordinators.
• Consult and communicate with staff, managers, directors, and other hospital departments as required to maintain efficient departmental operations.
• Provide education to clinicians and hospital departments on the High-Cost Therapy and the implementation of the therapy for the administering area(s).
• Collaborate with departmental leaders and research department to identify current studies in preparation for operationalizing medication within the organization.
• Provide feedback to providers on recommended medications and step-therapy according to Insurance Guidelines.
• Perform other duties as assigned.

Requirements

• At least 3 years acute care clinical nursing or medication management (Required)
• At least 2 years experience working with health insurance and reimbursement practices (Required)
• At least 2 years knowledge of UM and case management principles (Preferred)
• At least 2 years medication prior authorization experience (Preferred)
• Knowledge of Texas Medicaid requirements (Preferred)

Qualifications

• Four-year Bachelor's degree or equivalent experience
• BSN (Required)
• Current license to practice professional nursing in the State of Texas (Required upon hire)

Schedule

Monday through Friday, 8:00 AM to 5:00 PM. Remote, but there will be an expectation to come onsite 2 times a month as well as any events that require onsite attendance.

Benefits

• Employee portion of medical plan premiums are covered after 3 years
• 4%-10% employee savings plan match based on tenure
• Paid Parental Leave (up to 12 weeks)
• Caregiver Leave
• Adoption and surrogacy reimbursement

We welcome, value, and respect the beliefs, identities, and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute.