RN - Authorizations & Coordination

University of Arkansas•Little Rock, AR

3d•Onsite

About The Position

The RN will provide coordination and support for Allo Transplant patients throughout the evaluation, authorization, transplant, and post-transplant process. Collaborates with patients, providers, insurance, case managers, and interdisciplinary teams to facilitate required testing, obtain authorizations, ensure regulatory compliance, and promote continuity of care.

Requirements

Bachelor’s Degree, Associate’s Degree, or Diploma RN, with Major: Registered Nurse.
Minimum of 3 years of RN experience
Valid Arkansas Registered Nursing License
Current BLS

Nice To Haves

Case Management experience, 5 years or more
CCM or other Oncology related National Nursing Certification
Oncology, Stem Cell Transplant

Responsibilities

Coordinates outside new patient referrals.
Ensures that a verification of benefits is ran on every transplant candidate.
Reviews verification of benefits, and educates the patient on transplant coverage.
Works with Insurance Case Manager to open evaluation for stem cell transplant case.
Reviews outside records noting recommendations & works to obtain missing information or testing that is required for pre-transplant evaluation.
Participates in patient financial education of transplant, financial resources, and case manager role.
Refers patient to AR Medicaid enrollment or other payer sources.
Reviews charts to ensure that all payer required pre-testing is complete.
Gathers all clinical work-up and submit case for transplant authorization.
Notifies the MD, Clinic RN, TC, and BMT global notification email distribution group of the approval and if it is global or not.
Opens transplant cases with insurance companies and maintain contact throughout the process, and up to one-year post transplant.
Follows patient and provide clinical updates, every month or as required by insurance until the patient is 100 days post-transplant.
Follows CMS (Medicare) guidelines and audit patient charts to ensure that our transplants are within Medicare Guidelines.
Completes and has physician sign Internal Medicare Guidelines Form, when for Medicare patients.
Keeps track of global dates – inform the transplant team of global dates.
Appeals insurance denials with clinical documentation, letters of medical necessity if required.
Communicates with patients throughout the transplant process keeping them informed of where they are in the approval process.
Reports quarterly to the Cancer Institute Stem Cell Transplant QI Meeting: monthly number of referrals, approvals, consults.
Participate in meetings regarding reimbursement, contract negotiations, billing, etc.
Act as a liaison between inpatient case management and social work and outpatient social worker.
Maintain open communication on all transplant patients with insurance case managers.
Notifying them if patient is referred for a 2nd opinion, or to OSH for transplant, or that patient is no longer a candidate for transplant.
Reviews National Marrow Donor Program invoices.
Determine what donor charges are covered by an NMDP grant.
Notify Donor coordinator of when appropriate to ask for NMDP grants.
Submit paperwork for grants and keep accurate record of all grants.
Works with billing department to insure all grant moneys are appropriate, and if not work with them to insure refunds are issued.
Follows SOP Guidelines.
Stays current with trends in the industry by referencing of professional literature or publications, including Web-based information.
Must stay up to date with frequent insurance company changes and help providers and patients understand when the changes affect their care/treatment plan.
Perform other duties as needed.