Classified Title: CO Clinical Nurse Role/Level/Range: ACRP/03/ME Salary: Commensurate with Experience Status: Full-Time Department name: 10002808-SOM DOM Gastroenterology
Work Schedule/Hours: M-F 9-5 Location: 04-MD:School of Medicine Campus Personnel area: School of Medicine
The CO Cliniical Nurse is responsible for coordination with patient insurance for medications, procedures, laboratories and other diagnostic studies as required. Maintains active knowledge of insurance regulations and coordinates routinely with the office of Managed Care at Johns Hopkins. Demonstrates clinical understanding of gastrointestinal disease, common medications and endoscopic procedures. Exercises independent, professional judgement and decision making on a consistent basis. Adapts to change in technology and software. Utilizes multiple modes of communication including internet portals, faxes, telephone and written submissions to request prior authorizations. Maintains working protocols for various insurance policies to ensure efficient processes for prior authorizations submissions. Demonstrates professional communication with multiple members of the health care team including administration, physicians, nurses and office coordinators. Coordinates care with various specialty pharmacies. Maintains a working knowledge of patient assistance programs.
Specific duties & responsibilities:
Submit required forms using a variety of modalities to patient insurers to seek approval for medications, laboratory studies, endoscopic interventions and other physician ordered interventions as required.
Uses clinical judgement to determine urgency of the requests and manages time and work queues appropriately.
Engages in telephonic review of prior authorizations requests.
Maintains database of evidence based articles to support requests for interventions. Additionally maintains a database of letters of medical necessity by disease process and intervention.
Facilitates peer to peer requests when requested by the insurer.
Completes second level appeals for requested services using clinical judgement and the aforementioned databases.
Collaborates with various team members with the division electronically or telephonically to ensure real time understanding of the status of requests.
Educates providers and staff on utilization and medical management processes
Advises patients and providers of alternate and approved therapies when initial requests are denied. Maintains working knowledge of patient assistance programs.
Collaborates with industry representatives to maintain up to date knowledge on FDA approved dosing and avenues for assistance.
Documents properly in the EHR.
Maintains a database of chronic medications and dates of required renewal. Proactively works to prevent lapse in patient care due to expired authorizations.
Provides other clinical nursing duties such as referral and record review, patient education, coordination of diagnostic results and telephonic triage as requested by the nursing supervisor.
SPECIAL KNOWLEDGE, SKILLS, or ABILITIES/COMPETENCIES:
Demonstrated problem solving skills required.
Demonstrated ability for self-direction and initiation required.
Demonstrated ability to function as a leader and team player required.
Extraordinary customer service skills required.
Basic computer skills required. Experience with Epic preferred.
Individual must be a registered nurse, licensed in the State of Maryland or state where practicing. Bachelor's degree in nursing or related discipline preferred. Current American Heart Association or American Red Cross CPR certification required. Must maintain current licensure and certification during duration of employment. Acceptable completion of the JHH or BMC credentialing process is required within two weeks of start date.
The successful candidate(s) for this position will be subject to a pre-employment background check.
If you are interested in applying for employment with The Johns Hopkins University and require special assistance or accommodation during any part of the pre-employment process, please contact the HR Business Services Office at firstname.lastname@example.org. For TTY users, call via Maryland Relay or dial 711.
The following additional provisions may apply depending on which campus you will work. Your recruiter will advise accordingly.
During the Influenza ("the flu") season, as a condition of employment, The Johns Hopkins Institutions require all employees who provide ongoing services to patients or work in patient care or clinical care areas to have an annual influenza vaccination or possess an approved medical or religious exception. Failure to meet this requirement may result in termination of employment.
The pre-employment physical for positions in clinical areas, laboratories, working with research subjects, or involving community contact requires documentation of immune status against Rubella (German measles), Rubeola (Measles), Mumps, Varicella (chickenpox), Hepatitis B and documentation of having received the Tdap (Tetanus, diphtheria, pertussis) vaccination. This may include documentation of having two (2) MMR vaccines; two (2) Varicella vaccines; or antibody status to these diseases from laboratory testing. Blood tests for immunities to these diseases are ordinarily included in the pre-employment physical exam except for those employees who provide results of blood tests or immunization documentation from their own health care providers. Any vaccinations required for these diseases will be given at no cost in our Occupational Health office.
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