Clinical Nurse Navigator - Rheumatology

Good Shepherd Health Care•Hermiston, OR

5d•Onsite

About The Position

The Rheumatology RN Navigator provides comprehensive clinical and administrative support for patients with complex autoimmune and inflammatory diseases. This position serves as the primary clinical resource for patients throughout their treatment journey, coordinating care, providing disease-specific education, managing medication therapies, and facilitating communication between patients, providers, pharmacies, infusion centers, insurance companies, and multidisciplinary care teams. A primary responsibility of this role is managing specialty medication prior authorizations and appeals for biologic and targeted therapies, ensuring timely access to medically necessary treatment while minimizing delays in care. The RN Navigator collaborates closely with providers to obtain required clinical documentation, monitor treatment effectiveness, coordinate laboratory monitoring, and ensure compliance with payer requirements. The Rheumatology RN Navigator works under the supervision of the Clinic Nursing Supervisor or Practice Manager while collaborating with physicians, infusion services, pharmacies, referral coordinators, and other healthcare professionals to provide high-quality, patient centered care.

Requirements

Graduate of an accredited school of professional nursing.
Current, unrestricted Oregon Registered Nurse license.
Current BLS certification.
The ability to work with a culturally diverse population.
Knowledge of computers, phones, and other office equipment.
Knowledge in clinical equipment including but not limited to: EKG, vital sign monitoring devices, glucometer, scales, various lab testing equipment, etc.
Strong assessment and critical thinking skills
Excellent verbal and written communication abilities
Proficiency in patient education and health promotion
Ability to work independently and prioritize multiple tasks effectively

Nice To Haves

BSN
ACLS (Advanced Cardiac Life Support) certification
Specialty certification relevant to assigned clinic area (e.g., ANCC Rheumatology Nursing Certification (RN-BC)).
Bilingual and/or English Spanish speaking.
Minimum 2 years of clinical nursing experience.
Experience with Epic electronic health record system.
Knowledge of evidence-based practice and quality improvement methodologies

Responsibilities

Serve as the clinical lead for specialty medication prior authorizations, including biologics, biosimilars, JAK inhibitors, infusion therapies, and injectable medications.
Complete comprehensive prior authorization requests utilizing evidence-based clinical documentation and payer-specific requirements.
Prepare, submit, and monitor insurance appeals, peer-to-peer requests, and medical necessity documentation.
Coordinate with specialty pharmacies, infusion centers, insurance companies, pharmaceutical manufacturers, and provider offices to ensure timely medication approval and initiation.
Track authorization expirations and proactively initiate renewals to prevent interruptions in therapy.
Monitor payer formulary changes and recommend appropriate alternatives when needed.
Assist patients with enrollment in manufacturer copay assistance and patient assistance programs.
Maintain current knowledge of Rheumatology treatment guidelines and specialty medications.
Serve as the primary clinical contact for patients with chronic rheumatologic conditions.
Coordinate laboratory monitoring required for disease-modifying antirheumatic drugs (DMARDs), biologic therapies, and immunosuppressive medications.
Monitor patients for medication effectiveness, adverse reactions, infections, and treatment compliance.
Coordinate referrals between rheumatology and primary care, specialty providers, infusion centers, imaging departments, and laboratory services.
Ensure continuity of care throughout diagnosis, treatment initiation, medication changes, and long-term disease management.
Coordinate infusion scheduling to align with medication approval and treatment timelines.
Educate patients regarding autoimmune diseases, medication administration, side effects, infection prevention, immunizations, and lifestyle modifications.
Provide injection teaching for self-administered biologic medications.
Educate patients regarding laboratory monitoring schedules and medication safety.
Reinforce provider treatment plans and ensure patient understanding of disease management.
Manage Epic InBasket messages, patient portal communications, prescription refill requests, and provider messaging.
Perform telephone triage utilizing nursing judgment for symptom management and medication-related concerns.
Document all clinical interventions accurately and timely within the electronic medical record.
Coordinate prescription refills, specialty pharmacy communications, and medication monitoring.
Monitor prior authorization turnaround times, denial rates, medication access delays, and quality metrics.
Develop standardized workflows to improve efficiency of specialty medication approval processes.
Collaborate with providers and leadership to optimize medication access and reduce treatment delays.
Participate in quality improvement initiatives focused on patient outcomes, medication adherence, and access to care.
Performs other related duties as assigned.
Position requires flexibility to work evenings, weekends, and holidays as patient care needs and clinic operations dictate.
May be assigned to work across various medical specialties within the Good Shepherd Outpatient Clinics.