Infusion Referral Nurse Sr - REMOTE

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

The Infusion Referral Nurse Sr 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. This role 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.).

Responsibilities

• Provide site-of-service solutions for patients receiving care at non-preferred treatment locations, coordinating transitions to lower-cost alternatives (e.g., Hospital inpatient or outpatient facilities, non-pat cancer treatment centers, etc.)
• Educate members and providers on the financial impact of specialty drugs, facilitating agreement on cost-effective treatment sites
• Document and enter data following each case in web-based application and spreadsheets
• Coordinate drug infusions and related services at alternate treatment sites to reduce overall healthcare costs
• Support members with copay assistance programs and financial resources to minimize out-of-pocket expenses
• Apply clinical knowledge and critical thinking to connect members with resources that optimize treatment outcomes
• Maintain an active caseload, ensuring accurate documentation in web-based systems and spreadsheets in compliance with company policies and laws
• Validate prior authorizations and site-of-service cases, synthesizing clinical data to support product initiatives and workflows
• Other duties as assigned

Minimum Qualifications

• Bachelors degree in Nursing or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required

• 5 years of work experience in a clinical infusion setting
• Current Registered Nurse (RN) license to practice in the applicable state(s)

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• 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
• Possess the ability to achieve organizational goals through development of effective teams
• 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

Preferred Qualifications

• Experience in managed care, specialty drugs, care management and utilization review

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLCis 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 (including pregnancy), 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.

Positions will be posted for a minimum of five consecutive workdays.

Salary : $74,000 - $118,000