Clinical Home Infusion Coordinator Lead

3 weeks ago


New York, New York, United States EmblemHealth Full time
Responsibilities and Qualifications

Responsibilities:

  • Coordinate short-term care plans with members, physicians, facilities, and home infusion vendors.
  • Assess site of care utilization and ensure continued medical necessity reviews for prior authorization.
  • Communicate with MD offices regarding site of care programs.
  • Track and contact MDs providing scope drugs in higher-level care settings than necessary.
  • Transfer members from higher levels of care to Home/Ambulatory Infusion Suites for optimal outcomes.
  • Create Medical Drug dashboards reporting volumes and costs.
  • Identify and implement cost-saving strategies by shifting patient site of service.
  • Develop, facilitate, and communicate discharge plans with members, physicians, vendors, and case management teams.

Qualifications:

  • Graduate of an accredited 2-4 year nursing program.
  • Active, unrestricted RN or LPN license in the state.
  • Certification as a Case Manager (Preferred).
  • 5-10+ years of clinical experience in managed care, preferably including acute care.
  • Ability to use data analytics for decision-making and strategy.
  • Leadership experience with clinical staff.
  • Prior case management experience.
  • Excellent communication skills with all audiences.
  • Proficient in MS Office applications.


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