Shire Jobs

Description Location: This position is located at our Dublin, OH campus with hybrid flexibility. Multistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health. We're on a mission to make healthcare simpler and more effective. We fight to ensure our members get the care they need, when they need it, at the most affordable cost - that's what makes us Healthcare Warriors. If you'd like to join us, we'd love to talk to you - even if you don't match every single requirement. The Registered Nurse (RN) - Transplant Patient Care Guide 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. What you'll do 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. 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. 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. All other duties as assigned. What you'll bring Licensure: Active license in good standing as aRegistered Nurse(RN) in Ohio required. Education: Bachelor of Science in Nursing (BSN) preferred. Completion of specialized training in Advanced Achievement in Transplant Management (AATMC) or willingness to complete within two years of employment. Experience: 2+ years of clinical experience with direct patient care required; Proven clinical experience with organ and/or bone marrow transplants, preferred. Excellent verbal and written communication skills. Comfortable communicating with members and providers via phone regularly throughout the day. Ability to communicate effectively with members and providers in implementingclinical services; Translate complex clinical concepts for non-clinical audiences. Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently. Trustworthy and accountable behavior, capable of viewing and maintaining confidential personal information daily. What's in it for you Compensation: Competitive base pay, incentive plans and employee referral bonuses. Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insuranc