Nurse Infusion Specialist
2 weeks ago
EmblemHealth is seeking a skilled Specialty Infusion Nurse Lead to 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.
Key Responsibilities- Provide short-term care coordination with members, physicians, facilities, and home infusion vendors to ensure seamless transitions and optimal outcomes.
- Assess and ensure appropriate site of care utilization and continued medical necessity reviews for prior authorization to vendors.
- Communicate effectively with MD offices in relation to the Site of Care program and track and contact MDs identified as providing scope drugs in settings that are at a higher level of care than necessary.
- Assist in transferring members from higher levels of care to Home/Ambulatory Infusion Suites for optimal outcomes.
- Create a Medical Drug dashboard reporting the status of volumes and costs to identify and implement cost-saving strategies.
- Develop, facilitate, and communicate discharge plans in partnership with the member, physician, and vendor, and at times concurrent review team, case management, and social workers.
- Coordinate services from one setting to another, acute setting to home/Ambulatory Infusion Suites throughout the continuum of care.
- 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).
- 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).
- Strong 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).
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