High Cost Therapy Liaison RN

Job Title & Specialty Area: High-Cost Therapy Liaison RN

Department: Utilization Management

Location: Children's Health- Trinity Towers

Shift: Monday through Friday 8:00a to 5:00p

Job Type: Remote, but there will be an expectation to come onsite 2x a month as well as any events that will require onsite attendance

Why Children's Health?

At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.

Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.

Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.

Summary:

The High Cost Therapy Liaison RN is responsible for submitting accurate and timely medication authorizations. This includes but is not limited to communication with insurance providers, manufacturers, and clinical teams to assist with managing the authorization process of high-cost drugs. Serve as a subject matter expert for high-cost therapies to provide knowledge on insurance and FDA requirements provided at CHST to clinicians and departments. This role will require a strong analytical mind and attention to detail to navigate the complex regulations surrounding drug authorization and reimbursement.

Responsibilities:

• Collaborate with various staff within the provider network and health services team to obtain prior authorization and submission of appeals for high-cost therapies.
• Provide guidance and support to patients in navigating the authorization and approval process.
• Develop and maintain relationships with pharmaceutical manufacturers to ensure timely authorization and administration of medication therapies.
• Collaborate with other healthcare teams and departments to ensure all applicable steps have occurred to administer the High-Cost Therapies.
• Stay up to date with regulations and policies related to High-Cost Therapies.
• Assistance with coordination of Peer to Peers and Appeals when indicated.
• Utilization of payor portals to identify medical policies and authorization submission requirements
• Assist with effective problem-solving or general assistance to the Medication Authorization Coordinators. Consults and communicates with staff, managers, directors, and other hospital departments as required to maintain efficient departmental operations.
• Provide education to clinicians and hospital departments on the High-Cost Therapy and the implementation of the therapy for the administering area(s).
• Collaborate with departmental leaders and research department to identify current studies in preparation for operationalizing medication within the organization.
• Provides feedback to providers on recommended medications and step-therapy according to Insurance Guidelines.
• Performs other duties as assigned.

How You'll Be Successful:

WORK EXPERIENCE

• At least 3 years acute care clinical nursing or medication management Required
• At least 2 years experience working with health insurance and reimbursement practices Required
• At least 2 years knowledge of UM and case management principles Preferred
• At least 2 years medication prior authorization experience Preferred
• Knowledge of Texas Medicaid requirements Preferred

EDUCATION

• Four-year Bachelor's degree or equivalent experience BSN Required

LICENSES AND CERTIFICATIONS

• Current license to practice professional nursing in the State of Texas Upon Hire Required

A Place Where You Belong

We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.

Holistic Benefits - How We'll Care for You:

• Employee portion of medical plan premiums are covered after 3 years.
• 4%-10% employee savings plan match based on tenure
• Paid Parental Leave (up to 12 weeks)
• Caregiver Leave
• Adoption and surrogacy reimbursement

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.