RN, Registered Nurse -Transplant Case Manager

Quantum Health • Dublin, OH

13h • Hybrid

About The Position

The Registered Nurse (RN) – Transplant P ersonal Care G uide facili tates care coordination for a member with the potential for a transplant, including hematologic malignancies and end stage disease processes. The position requires a multidisciplinary, collaborative approach to ma nage the compl ex ity , financial i mpact, frequent reso urce utiliz ation and variable acuity across the transplant continuum. Management begins at referral and follows through pre-transplant care, evaluation, the transplant phase to post-transplant case closure.

Requirements

• Licensure: Active license in good standing as a Registered Nurse (RN) in Ohio required.
• Education: Bachelor of Science in Nursing (BSN) preferred.
• Completion of specialized training in Advanced Achievement in Transplant Management (AATMC) or willingness to complete within two years of employment.
• Experience: 2+ years of clinical experience with direct patient care required
• Excellent verbal and written communication skills.
• Comfortable communicating with members and providers via phone regularly throughout the day.
• Ability to communicate effectively with members and providers in implementing clinical services; Translate complex clinical concepts for non-clinical audiences.
• Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
• Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.

Nice To Haves

• Proven clinical experience with organ and/or bone marrow transplants, preferred.

Responsibilities

• Identify and assess members with the potential for solid organ or bone marrow transplant, end stage renal disease and hematologic malignancies.
• Engage telephonically with eligible members and transplant facility case managers to educate on plan structure related to transplant, facility selection, and travel and lodging reimbursement.
• Perform post discharge calls.
• Provide Utilization Management for Transplant listing requests for identified population.
• Maintain a working knowledge of all benefit plans and know where to access the needed information.
• Negotiate for services needed if no clear benefit exists or if the services can only be provided out of network.
• Collaborate with the Stop Loss Carrier and TPA vendors for all Transplant specific language, contracting, and claims payment provisions.
• Maintain working knowledge of how to secure Transplant Vendor contracts, single case rate agreements, access agreements, and negotiated agreements as required by client plan design.
• Be a clinical resource for all Quantum Health work groups.
• Work closely with and provide updates to internal client executives and employer contacts for transplant patients.
• Maintain contact with the QH clinical staff for transfer of cases when appropriate.
• Participate in new hire, clinical and pod staff training as needed or appropriate.
• All other duties as assigned.

Benefits

• Compensation: Competitive base and incentive compensation
• Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
• Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
• Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
• Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
• Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
• Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level