BioScrip, Inc. Chronic Care Nurse Navigator - Centralized Specialty Intake in Aurora, Colorado

Chronic Care Nurse Navigator - Centralized Specialty Intake

Location: Aurora, CO

Job Id: 5120

of Openings: 1

BioScrip, Inc. is the largest independent national provider of infusion and home care management solutions, with approximately 2,100 teammates and nearly 70 service locations across the U.S. BioScrip partners with physicians, hospital systems, payors, pharmaceutical manufacturers and skilled nursing facilities to provide patients access to post-acute care services. BioScrip operates with a commitment to bring customer-focused pharmacy and related healthcare infusion therapy services into the home or alternate-site setting. By collaborating with the full spectrum of healthcare professionals and the patient, BioScrip provides cost-effective care that is driven by clinical excellence, customer service, and values that promote positive outcomes and an enhanced quality of life for those it serves. Ours is a fast-paced dynamic work environment with room for new ideas and opportunities for career advancement. We offer a wide array of welfare benefits as well as Tuition Reimbursement, an Employee Referral Program, and a 401(k) Retirement Savings.

Due to our exceptional growth and success, we are recruiting for a Chronic Care Nurse Navigator - Centralized Specialty Intake to join our team!

SUMMARY

As a Chronic Care Clinical Navigator, you will be responsible for providing a complex medical review for chronic patient care, assessing the chart documents and the medical policy for insurance providers and effectively communicating the requirements met or not met, to internal and external customers to facilitate effective on-boarding of patients. This position will be responsible for working with all departments and referral sources to facilitate clean claims activity for both initial and reauthorization of assigned therapies.

Primary responsibilities will focus on (1) providing a Clinical Review of all new Specialty (and other therapies as assigned) referrals to determine if the payers criteria has been met, and if not, communicate and facilitate with the branch and sales team to ascertain any required supporting documents. (2) Submit initial authorizations with clinical documentation based on diagnosis and payer requirements. (3) Provide guidance and support to the Patient Onboarding Team – Specialty (and others as assigned) with verification and re-authorization process as needed. (4) Provide clinical guidance and support to the branch staff, sales, and Patient Onboarding Teams to decrease the time frame between referral and authorization. (5) Documentation and communication of each evaluation will be verbal, email and/or in the EMR.

ESSENTIAL FUNCTIONS

To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation.

  • Build a strong, direct relationship with internal branch and corporate team members that facilitate open communication and provides sound clinical support during on-boarding and reauthorization process for assigned patients by therapy.

  • Coordinate the authorization process with the Patient Onboarding Team, branch, and sales team to submit and obtain authorization based on payer criteria, and Formulary, in the shortest amount of time that minimizes referral source interruption.

  • Work directly with appropriate team in maintaining clinical responsibility following company’s nursing and pharmacy policy, as well as Nurse Leadership direction.

  • Communicate with the appropriate branch staff and sales on supporting documentation needed to qualify a patient for their benefits for with the highest opportunity to successfully obtain authorization, and alert teams when authorization is approved.

  • Perform Electronic Medical Record (EMR) audits on charts to confirm input matches documentation supported in the EMR. Work with intake to assist in correcting any deficiencies and/or trends noted.

  • Communicate in a professional manner under the guidelines of regulatory, licensing and accrediting agencies, the policies and procedure of BioScrip and Standards of Nursing and Infusion Nurse Society. Continue to expand knowledge base and understanding of the diseases and associated organizations that can impact your assessments of clinical and reimbursement analysis and recommendations.

  • Keeps abreast of State and Federal laws, licensure and ACHC guidelines which apply to home infusion services and ambulatory infusion suites.

  • Maintains orientation, training and continuing educational files on all direct report personnel.

  • Participates in the development of and adherence to all organization's policies, procedures and protocols.

  • Takes professional responsibility for self-protection during required work in potentially hazardous situation (e.g. handling cytoxic agents, blood and body fluids).

  • Earns and maintains certification by Company Continuing Education (CE) department to present Company CE programs when requested by sales and marketing teams.

  • Assists in providing information for educational programs for external nursing agency partners.

  • Ensures that the safety of the patient and staff is always the first priority.

  • Attends scheduled patient care conferences, in-services, departmental meetings, etc. as requested.

  • Maintains professional licensure, certification, and health requirements as well as demonstrates clinical competence.

  • Each employee is responsible for adhering to those performance programs, policies, procedures, guidelines and internal control standards established to guide the operation of the Company. Each employee must be made aware of and understand proper internal control procedures associated with their specific job function as communicated by his/her manager.

  • Each employee is responsible for reporting concerns that he or she may have with respect to deficiencies in internal control.

  • Managers and supervisors must acknowledge that utilization of internal controls is an inherent part of a manager’s responsibility, not a new or additional function, and assure that internal controls are supportive of and consistent with the operating mandate and philosophy of the Company.

  • Performs other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS

Education:

  • RN Diploma, Associates or B.S. degree in nursing

  • Registered Nurse with current license in state of employment. Additional licensure may be required in -multi-state service areas. Graduate of an accredited school of nursing required, MSN preferred.

Experience:

  • Minimum five (5) years of nursing experience required with home health experience preferred

  • Ability to travel to other Home Solution’s locations, attend conferences or other events as assigned (<10% travel overall).

  • Strong computer skills with excellent customer service skills (written and verbal) a must.

  • Strong critical thinking and problem solving skills.

  • Reliable transportation.

Preferred Qualifications:

  • Registered Nurse with at least 5+ years clinical experience

  • Home healthcare/home infusion experience

  • CRNI, IgNS certification or eligible

Computer Skills:

  • Intermediate computer skills and proficiency in MS Excel, Word, Outlook, and PowerPoint required; experience with electronic applicant tracking system strongly preferred.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

The requirements listed below are representative of the knowledge, skill, and/or ability required, with or without reasonable accommodation.

  • Excellent interpersonal, verbal & written communication skills and organizational skills required.

  • Knowledge of accreditation standards, laws and regulations and industry standards of practice.

  • Works independently, demonstrates leadership in the practice of infusion nursing.

  • Knowledge of professional nursing theory and scope of practice to assess patient needs and administer and evaluate patient supportive care.

  • Ability to train employees.

  • Supports and promotes departmental goals and initiatives.

  • Skill in effective consensus building.

  • Strong interpersonal and communication skills. Ability to work cooperatively and effectively with branch departments and department team members.

  • Ability to maintain confidentiality and HIPAA compliance.

  • Ability to promote a compassionate, caring, customer service oriented culture by operating in a professional and collaborative fashion.

  • Knowledge of computerized information systems.

  • Plans and organizes work effectively.

  • Prioritizes responsibilities and workloads.

  • Displays a neat, clean, professional appearance or demeanor at all times.

  • Ability to conduct analysis and understand the value of Evidence Based Practice.

  • Proficient in MS Office.

Language Skills

Ability to read, analyze and interpret clinical information appropriate to duties and responsibilities assigned. Ability to operate information systems, follow policy, complete required forms, and prepare reports. Ability to effectively present information and respond to questions from referral sources, managers, patients, employees, payors and the general public.

Mathematical Skills

Ability to perform basic mathematical calculations.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of abstract variables.

BioScrip is an equal opportunity employer. All employment decisions are made without regard to age, color, race, ancestry, national origin, disability, genetic information, military status, religion, creed, sex, pregnancy, childbirth, marital status, citizenship, sexual orientation, gender identity, gender expression, legally protected medical condition, or any other basis prohibited by applicable law. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.