Nurse Liaison/Case Manager (RN) - Medical Oncology

Purpose:

UPMC Hillman Cancer Center is internationally recognized for its leadership in the prevention, detection, diagnosis, and treatment of cancer and is the region's only comprehensive cancer center designated by the National Cancer Institute.

As the preeminent institution in western Pennsylvania for the delivery of cancer care, the performance of basic, translational, and clinical research, and the education of the next generation of cancer researchers and physicians, UPMC Hillman Cancer Center is exceptionally well-positioned to contribute to the global effort to reduce the burden of cancer.

UPMC Hillman Cancer Center is currently hiring for a Care Manager/Nurse Liaison (RN) to support the Hillman Cancer Center team in Pittsburgh/Shadyside, PA. This position offers a $6,000 sign-on bonus and will work a Regular Full-Time daylight schedule Monday through Friday. It will work on the 3rd floor of the Hillman Cancer Center and will float responsibilities to other floors as needed with Work from Home capabilities after training and work commitments have been met.

This position will support the authorization needs of the Hillman Cancer Center, with a focus on Medical Oncology patient workups. The role includes but is not limited to obtaining authorizations for radiology imaging, oncologic and supportive medications, testing, inpatient, and prework-up transplant cases.

Responsibilities:

• Adapt quickly to changing conditions, assimilating new processes into job functions and taking ownership.
• Display effective time management and organizational skills to identify, prioritize and reach goals and objectives faster and easier, cope with multiple demands in a timely manner, and overcome changing priorities.
• Maintain knowledge of SI/IS criteria for commercial, Medicare, and Medicaid insurance products.
• Interpret insurance contract guidelines and expectations and make recommendations for compliance.
• Actively live and demonstrate University of Pittsburgh Medical Center Health System core values.
• Communicate and work with physicians, physician office personnel, associates, case managers, third party payer review personnel, and others in order to expedite the intake/utilization review process to avoid negative financial impact on the facility.
• Serve as a change agent, coach, mentor, team builder and facilitator.
• Maintain strict confidentiality within and outside the organization.
• Interpret third party payor contract requirements and recommend, design and implement procedures for compliance with regulations and standards.
• Possess self-motivated spirit and seek educational opportunities to increase professional competency.
• Interpret complex medical data to analyze applicability of review criteria to ensure optimal patient care while maximizing reimbursement.
• Use knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts.
• Maintain creativity in making process recommendations.
• Serve as a role model to others.
• Display dynamic communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers.
• Assist in the design and implementation of a program that elicits desired outcomes on an organizational level.
• Handle a high degree of pressure, heavy workloads, multiple requests, numerous interruptions, and short deadlines in a positive manner, establishing priorities for effective work completion.
• Effective critical thinking, problem solving and decision making skills.
• Demonstrate patient assessment skills and knowledge of patient acuity levels.
• Successfully plan, monitor, support and improve multiple activities.
• Negotiate with insurance vendors, medical directors, and third party payors when appropriate in order to facilitate the delivery of care in the most appropriate setting.

• Bachelor's Degree from an accredited school of nursing/allied health preferred.
• 3-5 years of progressive nursing in an acute care setting with at least one (1) year of experience in utilization review or managed care required.
• Previous authorization experience and strong interpersonal skills with knowledge of behind-the-scenes insurance processes and coding is preferred
• Extensive knowledge of clinical symptomology and related treatment required.
• Knowledge of 3rd party payer review criteria.
• Patient assessment skills and knowledge of patient acuity levels.

Licensure, Certifications, and Clearances:
CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire

• Registered Nurse (RN)
• Act 34

• Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.