Clinical Nurse

General Summary/Purpose

The department of Gastroenterology is seeking a Clinical Nurse for primary responsibilities related to providing comprehensive clinical support necessary in coordination of the day-to-day clinical operations for the Division of Gastroenterology and Hepatology. The primary duties of the prior authorization coordinator include but are not limited to obtaining prior authorization for medications and endoscopic interventions, as well as working collaboratively with the multidisciplinary health care team to provide clinical care and support within the ambulatory practices to optimize team performance.

Specific Duties & Responsibilities

The prior authorization coordinator works to support the Johns Hopkins Gastroenterology and Hepatology division in the prior authorization process. Responsible for detailed and timely communication to both the payers and clinical practices in order to facilitate compliance with payer requirements and is responsible for documenting the appropriate information in the patient’s electronic record.

• Contact patient insurance companies to obtain prior authorizations as indicated.
• Detailed and timely communication to both payers and clinical practices in order to facilitate compliance with payer requirements.
• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to request.
• Successfully works with payers via electronic/telephonic and/or fax communications.
• Submits required forms using a variety of modalities to patient insurers to seek approval for medications, laboratory studies, endoscopic interventions and other physician orders interventions as required.
• Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for documentation of benefits.
• Determines the urgency of the requests and manages time and work queues appropriately.
• Maintains database of evidence bases articles to support requests for interventions. Additionally maintains a database of letters of medical necessity by disease process and intervention.
• Facilitates and participates in peer-to-peer reviews when requested by the insurer.
• Completes second level appeals for request services using clinical judgement and the aforementioned databases.
• Collaborates with various team members within 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.
• Provide direct clinical care and support to outpatient practices, to include but not limited to triaging and responding to patients, as well as other aspects of coordination of care.
• Other duties as assigned

Minimum Qualifications

• BSN preferred.
• Two years of direct patient care experience preferred.
• Experience with/knowledge of insurance regulations and prior authorization process.

LICENSURE, CERTIFICATION AND REGISTRATION:

• Current Maryland State RN Licensure required.
• Completion of the JHU credentialing process to include verification of CPR certification is required prior to start date.
• Must maintain current licensure and certification during duration of employment.
  

Special Knowledge, Skills, and Abilities

• Demonstrated problem solving skills required.
• Demonstrated ability for self-direction and initiation required.
• Demonstration of responsibility and accountability to patients, family members, and other member of the health care team required.
• Demonstrated ability to function as a leader and team played required.
• Extraordinary customer service and communication skills requires.
• Basic computer skills required. Experience with Epic preferred.
• Ability to work remotely as directed.
  

PHYSICAL REQUIREMENTS:

• Ability to stand, walk or sit for an extended period of time.
• Communication skills using the spoken word.
• Ability to see and hear within normal parameters; manual dexterity and hand-eye coordination.
• Possible exposure to communicable diseases

Classified Title:Clinical Nurse
Working Title: Clinical Nurse ​​​​​
Role/Level/Range: ACRP/03/ME
Starting Salary Range:$60,945 - $83-865; Commensurate with experience
Employee group: Full Time
Schedule: Monday - Friday, 8:30am-5:00pm / 37.5 hours per week
Exempt Status: Exempt
Location: 04-MD:School of Medicine Campus
Department name: 10002808-SOM DOM Gastroenterology
Personnel area: School of Medicine

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 atjhurecruitment@jhu.edu. 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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