Transplant Nurse Care Coordinator (RN)

Clinical Columbus, Ohio


Description

The Transplant Nurse Care Coordinator facilitates 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 manage the complexity, financial impact, frequent resource utilization 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.

Essential Roles and Responsibilities

  • Clinical Care Coordination: 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.
  • Vendor Support: 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.  
  • Internal Resource Support: 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. 

Skills and Qualifications

  • Registered Nurse with active license in Ohio
  • Minimum of 2 years clinical experience involving direct patient care
  • Bachelor’s degree in nursing or closely related field or equivalent experience
  • Certification in Case Management preferred
  • Outstanding computer skills including Microsoft applications
  • Excellent critical thinking skills
  • Possess excellent verbal and written communication skills
  • Possess excellent time management skills
  • Demonstrate ability to work autonomously
  • Solid organ or bone marrow transplant experience desired
  • Completion of specialized training in Advanced Achievement in Transplant Management (AATMC) or willingness to complete within two years of employment