Job Details

Infusion Referral Nurse Sr- Remote

Our work matters. We help people get the medicine they need to feel better and live well. It fuels our passion and drives every decision we make.

Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility. Discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office, and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.). Performs functions under supervision.

Responsibilities include:

• Providing site of service solutions to patients seeking care at non-preferred treatment sites.
• Discussing the financial aspect of the specialty drugs to both the member and the ordering physician and to agree to find a lower cost versus higher cost sites of service.
• Providing member with resources to optimize their treatment outcomes.
• Supporting member copay-assistance programs, research and coordination to decrease member out of pocket financial responsibility.
• Maintaining a required case load and the activities to reach overall goals of switching site of service treatment to a lower cost setting.
• Documenting and entering data of these cases in web-based application and spreadsheets.
• Supporting clinical services such as the appeals program.
• Participating in meetings and consulting with management on regular basis.
• Maintaining appropriate par levels of literature.
• Familiarizing self with community resources available, benefit information or any other information that is valued with the program.
• Maintaining an active case load and accurate case records, adhering to all company policies and laws governing patient records.
• Performing related duties as requested.

Minimum qualifications include:

• Associates - Nursing
• Bachelors - Nursing
• RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
• 5+ years Clinical Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional qualifications include:

• Registered Nurse (RN).
• 5 years of post-degree clinical experience.
• Experience in managed care, specialty drugs, care management and utilization review.
• Meets Credentialing criteria.
• At minimum must have current and active nursing license.
• Ability to apply knowledge in relation to clinical findings from evidence based guidelines.
• Ability to function independently and as a team member.
• Good organizational, time management and communication skills.
• Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs.
• Understanding of the clinical aspect of the infusion of those drugs within various sites of service.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer.