Clinical Strategy and Practice Lead Pharmacy Home Infusion Network

3 weeks ago

Farmington, New Mexico, United States CenterWell Full time

*Become a part of our caring community and help us put health first*

The Clinical Strategy and Practice Lead builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise. The Clinical Strategy and Practice Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Clinical Strategy and Practice Lead Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

+ Delegation Oversight of Home infusion Nursing Vendors and local providers

+ Supervise through qualified vendors, personnel who provide nursing care.

+ Reconciles monthly vendor billing and budgeting through appropriate tools, reporting and data analytics

+ Coordinates with accounting and finances as necessary

+ Holds quarterly business reviews with nursing vendors and as necessary

+ Reviews and updates vendor contracts with procurement as necessary

+ Ensure that the professional standards of community nursing practice are maintained by all nurses providing care.

+ Creates and maintains performance improvement plans

+ Facilitates in the information security agreements

+ Approves and reconciles monthly invoices

+ Fosters external vendor relationships.

+ Facilitate training and credentialing of nursing vendors

+ Understands the regional needs of CWSP patients and the geography of the nursing vendors available

+ Creation of action plans to close geographic gaps

+ Builds and expands nursing vendor contracts or local vendors to meet the business needs

+ Creates internal infrastructure for internal nursing collaborations and vendor relationship as well as delegation oversight of them

+ Works with IRC to develop and execute intracompany agreements, training and many of the delegation oversight listed above

+ Home infusion Therapy Accreditation and Pharmacy accreditation for infusion nursing services, NABP, URAC, ACHC

+ Participate in audits as necessary

+ Build appropriate reporting, policies and procedures, and internal infrastructure to support accreditation requirements

+ Oversight of home infusion reporting for third party payer contracts

+ Monitor the following key functions:

+ Program evaluation

+ Risk Management

+ Utilization Review

+ Patient Care Evaluation

+ Policies and procedures

+ Human resources

+ Environment of care

+ Surveillance, prevention, and control of infection.

+ Prepare Performance Improvement reports and submit to Leadership as required

+ Recommend, obtain approval for, and monitor corrective action to be undertaken if problems are identified.

+ Maintain and adhere to facility procedure and patient care policy manuals.

+ Establish service policies and procedures in compliance with state health statutes and administrative rules, including CDC and OSHA guidelines for safety, standard precautions, and infection control procedures.

+ Directs, plans and coordinates the service activities and staffing performance of professional nursing and auxillary nursing personnel in rendering quality patient care

+ Create policies and procedures for evaluation of infusion nursing personnel.

+ Stays informed about changes in the field of nursing and home infusion

+ Exhibits and maintains knowledge of infusion nursing, pharmacy services, payment practices and overall understanding of infusion business

+ Identifies and helps to resolve gaps between local and best practices

+ Serves and protects the pharmacy by adhering to professional standards, company policies and procedures, federal, state, and local requirements and URAC/ACHC standard of care

+ Create appropriate training for administration of CWSP home infusion drug list

+ Set or adopt policies for, and keep records of criteria for admission to service, case assignments, and case management.

+ Represent the pharmacy in a professional and courteous manner in all interactions with patients.

+ Determine correct resolution to patient complaints; take corrective action, and monitor results.

+ Communicate with billing department to ensure proper billing to insurance companies, contracts, other third party payers and patients for all products and services delivered

+ Participate in surveys conducted by authorized inspection agencies.

+ Participate in committees when requested.

+ Pursue continuing education programs appropriate to job responsibilities.

+ Assist in internal and external audits

+ Opportunity to create and

+ Perform other duties as assigned by supervisor.

Required Qualifications

+ Graduate of an accredited school of nursing and current RN state license in good standing OR a graduate of an accredited school of pharmacy and current RPH/PharmD state license in good standing

+ Minimum 5 years nursing practice or pharmacy practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care

+ Minimum 5 years nursing practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care

+ Minimum 5 years nursing practice or pharmacy practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care

+ Minimum 2 years management experience, proven ability to lead, train and educate staff on new protocols and existing standard operating procedures

+ Previous experience in establishing and maintaining a home infusion nursing network for Specialty pharmacies

+ Clinical expertise in IV therapies with monitoring, skill and knowledge of IV lines and specialty products provided in the home

Preferred Qualifications

+ Effective interpersonal, time management and organizational skills.

+ Excellent oral and written communication, interpersonal, and resource management skills

+ Organizational skills sufficient to maintain consistently accurate records.

+ Ability to recognize and direct information to the appropriate health care provider.

+ Computer skills that include proficiency with spreadsheets, word processing and efficient use of the internet and e-mail.

+ Ability to successfully execute projects and initiatives in cross functional matrixed environment

+ Ability to work with all levels of employees in a fast paced clinical environment and manage complex projects

+ Knowledge accreditation standards relating to home infusion

+ Insurance reimbursement knowledge and health insurance billing experience.

*Use your skills to make an impact*

Humana values personal ident.

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