Clinical Development Lead, Transplant Expansion / New Indications
BiogenSalary not specified
Full Time
Senior (5 to 8 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- Associate's degree (AS) in nursing and minimum of 3 years of clinical experience; or any combination of education and experience providing an equivalent background
- Current unrestricted RN license in applicable state(s)
- Must reside in Florida
Responsibilities
- Conduct assessments to identify individual needs and develop specific care management plans to address objectives and goals
- Implement care plans by facilitating authorizations/referrals within benefits structure or through extra-contractual arrangements
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate effectiveness of care management plans and modify as needed
- Interface with Medical Directors and Physician Advisors on development of care management treatment plans
- Assist in problem solving with providers, claims, or service issues
- Assist with development of utilization/care management policies and procedures
- Collaborate with healthcare providers and members to promote quality outcomes, optimize benefits, and promote effective resource use for complex medical transplant issues
- Assess medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out-of-network services, and treatment setting appropriateness using medical policy and industry standards
- Conduct pre-certification, retrospective, out-of-network, and treatment setting reviews to ensure compliance with criteria, medical policy, eligibility, benefits, and contracts
- Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract
- Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care
- Collaborate with providers to assess needs for early identification and proactive discharge planning
- Facilitate member care transitions through the healthcare continuum and refer treatment plans/plan of care to clinical reviewers as required (without issuing non-certifications)
- Continue to learn and take on increasing work assignments in preparation for advancement to senior level
- Facilitate accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
Is this transplant nurse position remote?
Yes, this is a virtual full-time role with maximum flexibility and autonomy, except for required in-person training sessions. Applicants must reside in Florida.
What are the shift hours for this Transplant Nurse II role?
The shift is Monday through Friday from 12pm to 8:30pm EST.
What skills are required for the Transplant Nurse II position?
The role requires skills in assessing, developing, implementing, coordinating, monitoring, and evaluating care plans; conducting assessments and facilitating authorizations/referrals; coordinating resources; interfacing with Medical Directors; and conducting pre-certification reviews within the scope of licensure.
Where do applicants need to live for this Transplant Nurse II job?
Applicants must reside in Florida. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted.
What experience or qualities make a strong candidate for Transplant Nurse II?
Strong candidates have case management experience in transplant services, ability to handle increasing work assignments for peer role advancement, and skills in medical necessity assessments, care plan coordination, and collaboration with providers for complex transplant issues.
Elevance Health
Integrated health services and digital platform
About Elevance Health
Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.
Indianapolis, IndianaHeadquarters
1944Year Founded
$309.4MTotal Funding
IPOCompany Stage
Enterprise Software, Social Impact, HealthcareIndustries
10,001+Employees
Benefits
Medical, dental, & vision insurance
401(k) + match
Paid holidays
Paid Time Off
Incentive bonus programs
Stock purchase plan
Life insurance
Wellness Programs
Financial education resources
Adoption & Surrogacy Assistance
Dependent-care Flexible Spending Account (DCFSA)
Parental Leave
Parental Transition Week
Critical Caregiving Leave
Risks
Departure of CFO John Gallina may create a gap in financial leadership.
Lawsuit against CMS over MA Star Ratings could lead to financial penalties.
CareBridge integration may face operational challenges, disrupting service delivery.
Differentiation
Elevance Health integrates whole health approach with digital health platform for comprehensive care.
Acquisition of CareBridge enhances home health services within Carelon division.
Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.
Upsides
AI integration in home health services can reduce hospital readmissions and improve outcomes.
Predictive analytics support early disease detection, aligning with Elevance's whole health approach.
Telehealth expansion offers opportunities to reach more patients remotely.
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