Clinical Nurse Lead

4 weeks ago


New York, New York, United States EmblemHealth Full time
Job Summary

EmblemHealth seeks a skilled Clinical Nurse Lead - Specialty Infusion to coordinate Home Infusion services that achieve optimal benefit and results from the comprehensive management of members with chronic and/or catastrophic illness. The ideal candidate will provide focus on transition activities to benefit clinical needs of members, combining utilization of medical care and pharmacy to ensure coordination of health care delivery, member education, and preventative intervention.

Key Responsibilities
  • Provide short-term care coordination with members, physician, facilities, and home infusion vendors.
  • Assess appropriate site of care utilization and continued medical necessity reviews for prior authorization to vendors.
  • Ensure communication with MD offices in relation to Site of Care program.
  • Track and contact MD identified as providing scope drug in setting that is at a higher level of care than necessary.
  • Assist transfer of members from higher level of care to Home / AIS setting for optimal outcomes.
  • Create a Medical Drug dashboard reporting the status of volumes and costs.
  • Identify and implement cost-saving strategies by shifting the patient site of service.
  • Develop, facilitate, and communicate discharge plans in partnership with the member, physician, and vendor.
Requirements
  • 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).
  • 5 – 10+ 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).
  • 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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