Transplant Nurse Advisor

About the role

Under general supervision, manages covered individual transplant needs related to the applicable transplant benefit contract. Provides support in the ongoing development of transplant medical policy. Provides review support to Underwriting and Claims for risk assessment.

Responsibilities

• Perform all intake and initial case set-up for new transplant patient referrals.
• Conduct due diligence for potential preexisting conditions on new referrals.
• Communicate with referral source, patient, attending physician, hospital, and transplant team to obtain necessary information for coverage determination as well as quote transplant benefits.
• Facilitate review of medical information by Medical Director for medical necessity and experimental/investigational determination under the applicable transplant benefit contract.
• Provide initial and ongoing education about transplantation to the patient.
• Maintain regular contact with patient, transplant team, and referral source as applicable throughout the transplant benefit period.
• Facilitate access to transplant network centers.
• Assess, plan, facilitate, and coordinate the delivery of care for transplant patients.
• Monitor patient health status and compliance to treatment plan throughout transplant benefit period.
• Initiate discharge planning as well as medical necessity for home health care and/or skilled nursing needs.
• Coordinate transplant related medical appointments and make necessary community resource referrals.
• Document all activities related to transplant case management in the patient record in the excess database.
• Audit disclosed potential transplant candidates and assess for future risk in support of the transplant underwriting process.
• Review claims to determine transplant versus non-transplant related services as needed.
• Keep database updated on all transplant center clinical contacts.
• Travel as requested (minimal).

Requirements

• 4 Year / Bachelors Degree Nursing, a related field, or the equivalent education and/or experience.
• 5 Years relevant and progressive professional nursing experience in Case Management, preferably in Transplant Case Management.
• Clinical Transplant Program Management And/or Oncology Nursing Experience Preferred.
• Experience in Transplant Medical Policy a plus.
• Active, current, and unrestricted state Registered Nurse (RN) License.
• Experience in Transplant Medical Policy a plus.
• Broad knowledge base in disease states, progression and management, especially end-stage organ/tissue diseases and their treatment.
• Ability to communicate assertively, effectively, and collaboratively with management, staff, hospitals, physicians, and patients.
• Possess and have ability to apply broad knowledge of principles, practices, and procedures.
• Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy.
• Demonstrated ability to manage multiple tasks simultaneously.
• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment.
• Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word).

Qualifications

• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment.
• Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word).

Skills

• Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment.
• Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word).

Benefits

Competitive salary and comprehensive benefit package

Strong learning culture with ongoing development opportunities

Opportunities for growth and career advancement

Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment

Basic life and disability insurance

401(k) plan with 6% company match

20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off

Paid parental leave

Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription

Student loan matching program

Employee discount program

An opportunity to do meaningful work and love what you do

The pay range for this position is $63,400-$140,000, which includes geographic adjustments, where applicable.

The pay range is the range THMCC, in good faith, believes is the range of compensation for this role at the time of this posting.

The hired applicant will be offered pay within the entire range based on the candidate’s geographic location, qualifications, work experience, education, and/or skill level.

The Company is fully committed to ensuring equal pay opportunities for equal work regardless of color, race, sex, national origin, sexual orientation, religion, age, veteran status, disability, pregnancy, citizenship status, genetic information, or any other basis protected by federal, state, or local pay equity laws.