RN - Authorizations & Coordination

Department

• ICE |
• CORE
• PA
• Cancer
• Medical
• Authorization
• Department's
• Website:
• Summary of
• Job
• Duties: 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.

Qualifications

Minimum Qualifications

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

Preferred Qualifications

Case Management experience, 5 years or more CCM or other Oncology related National Nursing Certification Oncology, Stem Cell Transplant This position WILL have patient contact or other duties that will require: Annual TB (UAMS Policy 4.5.18) Background Check (UAMS & Medical Center Policy HR.3.02) Drug Test (UAMS Policy 3.1.14) Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this position at any time. Changes in duty and/or schedule can be made based on business needs, with a two-week notice to the employee.

Additional Information

Job Requirements: 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. Dependent upon insurance requirements. Once approval is received, 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. PHYSICAL REQUIREMENTS Stand: Frequently Sit: Frequently Walk: Occasionally Bend, crawl, crouch, kneel, stoop or reach overhead: Frequently Lift and carry weight: 25 lbs Push and pull weight: 25 lbs Use hands to touch, handle or feel: Frequently Talk: Continuously Hear: Continuously Taste or smell: Occasionally Read, concentrate, think analytically: Continuously Physical Environment: Inside Medical Facility Environment Salary Information: Commensurate with education and experience Required Documents to Apply: License or Certificate (see special instructions for submission instructions), List of three Professional References (name, email, business title), Resume

Optional Documents

Proof of Veteran Status Special Instructions to Applicants: Recruitment Contact Information: Please contact askrecruitment@uams.edu for any recruiting related questions. All application materials must be uploaded to the University of Arkansas System Career Site https://uasys.wd5.myworkdayjobs.com/UASYS Please do not send to listed recruitment contact. Pre-employment Screening Requirements: Annual TB Screening, Criminal Background Check, Substance Abuse Testing This position is subject to pre-employment screening (criminal background, drug testing, and/or education verification). A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity. The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law. Constant Physical Activity: Feeling, Hearing, Manipulate items with fingers, including keyboarding, Repetitive Motion, Sitting, Talking Frequent Physical Activity: Grasping, Reaching, Standing, Walking Occasional Physical Activity: Crouching, Kneeling, Lifting, Pulling, Pushing, Stooping Benefits Eligible: Yes The University of Arkansas System is a comprehensive, publicly-supported higher education institution composed of 18 unique campuses, divisions and administrative units that share the singular goal of serving Arkansas residents and others by developing and sharing knowledge to impact an ever-changing world. The UA System provides access to academic and professional education, and develops intellectual growth and cultural awareness in its students, staff and faculty. The system further promotes an atmosphere of excellence that honors the heritage and diversity of our state and nation. It provides students, researchers and professionals with tools to promote responsible stewardship of human, natural and financial resources in Arkansas and around the globe, and with workforce-relevant knowledge to enhance economic development efforts that improve the overall quality of life and societal well-being. Universities University of Arkansas, Fayetteville University of Arkansas at Little Rock University of Arkansas for Medical Sciences University of Arkansas at Monticello University of Arkansas at Pine Bluff University of Arkansas at Fort Smith The University of Arkansas System eVersity Two-Year Colleges Phillips Community College of the University of Arkansas University of Arkansas Community College at Hope-Texarkana University of Arkansas Community College at Batesville Cossatot Community College at the University of Arkansas University of Arkansas Community College at Morrilton University of Arkansas Community College at Rich Mountain University of Arkansas Pulaski Technical College Other Units University of Arkansas System Division of Agriculture Arkansas Archaeological Survey Criminal Justice Institute Arkansas School for Math, Sciences, and the Arts University of Arkansas Clinton School of Public Service Arkansas Research and Education Optical Network (ARE-ON)