Registered Nurse Navigator (Outpatient Pharmacy), Full Time Days

Holland Hospital•Holland, MI

33d•Onsite

About The Position

Using the nursing process, the Infusion Pharmacy Nurse Navigator’s function is guiding patients and their providers through the complex process of accessing recommended infusion and healthcare provider administered therapies. In partnership with various hospital departments this may include benefits verification, prior authorization, financial navigation, site of care optimization, denial management, communication with providers, and most importantly patient education and support.

Requirements

Registered Nurse
BSN or MSN
2-3 years of experience working in an ambulatory setting
BLS for the Healthcare provider certification (or completed within 60 days of hire)
Proficiency in Microsoft Office suite products (Outlook, Teams, Excel, Word)
Electronic Medical Record (eClinicalWorks, Cerner, PioneerRx, CoverMyMeds, Payer Portals such as Availity, etc.)
High level written, verbal, phone and email-based communication skills
High level patient and customer service-orientation
Proficiency with navigating electronic medical records and payer portals
Organizational skills to manage multiple patients through the continuum of care
Self-directed, with strong ability to multi-task
Works collaboratively as part of an interdisciplinary team
Knowledge of community resources
Current licensure as RN in the State of MI
CPR
BLS
Graduate of an accredited Registered Nursing Program required
Current Michigan RN license required

Nice To Haves

Ambulatory infusion experience Preferred
Experience with care coordination, case management, prior authorization, medical and/or pharmacy billing, managing claim denials

Responsibilities

Assists patients in understanding their diagnosis and medication therapy
Works with finance for benefits verification to determine medical and/or pharmacy billing strategy and optimal site of care
Processes prior authorization for infusion and/or healthcare provider administered therapies
Denial management including support for appeals and letters of medical necessity
Coordinates with members of the multidisciplinary care team as needs are identified to ensure smooth transitions and handoffs
Communicate with prescribing providers and/or payers as needed to establish plan of care
Creation and documentation of a plan of care using the nursing process to assess, plan, implement and evaluate care provided from prescription through administration
Ensures patient has appropriate education related to treatment including drug, benefits/risks of treatment, side effects, safe administration, emergency response
Guides connections to manufacturer or community-based resources related to disease education, management, support and financial assistance
Participate in a regular quality management committee (QMC) to identify, implement and monitor performance improvement
Provide excellent support for navigating the complex nature of ambulatory infusion therapy as evidenced by patient and provider satisfaction, successful implementation of evidence-based, high-quality, cost-effective care.
Assists with development and implementation of new or revised practices, protocols, or policies related to ambulatory infusion therapy.