Medical Policy Specialist (RN/LPN) - Front End Referral Review

Vivo Infusion, LLC

Medical Policy Specialist

Remote

Medical Policy Specialist

If you are a Registered Nurse or LPN/LVN looking to leverage your experience to make a difference in your patients' lives while working in a remote setting, we have an incredible opportunity for you!

Vivo Infusion is looking for a Licensed Practical/Vocational Nurse (LPN/LVN) or Registered Nurse (RN) with a clinical eye to assist with front-end referral review for insurance medical policy. The Medical Policy Specialist (MPS) will utilize their clinical experience and expertise to review medical records, and test results to assist with preparation prior to insurance submission to ensure exceptional and efficient patient-centered care. Experience working with insurance authorization is required for this position, Infusion experience is preferred.

The Medical Policy Specialist will work remotely from a home office with a secure network. Only candidates residing in the states below at the time of employment will be considered.

Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Wisconsin, Wyoming, Washington D.C.

Compensation:

• $35.00 - $38.00/hour

• 5% Annual Bonus Potential (Performance Based)

• Private Equity for the Greater Good - Company-wide Employee Ownership Program

Benefits Offered:

• Medical, Dental, Life, Vision

  • Option for HSA w/ Employer Contribution

• 401K with Match up to 4%

• PTO: Accrual 4+ weeks/YR

• Wellness Reimbursement Program

• Employee Referral Bonus

• Tuition Assistance Program

• Employee Assistance Program

• Short & long-term disability

• & More

Employment Type & Schedule, FLSA Status:

• Full-Time

• Monday-Friday

• Non-Exempt

Location: Remote

Reports to: Medical Policy Manager

Primary duties and responsibilities:

• Review incoming referrals against FDA and insurance-specific clinical coverage guidelines to ensure compliance with medical necessity, safety requirements, and to minimize financial loss

• Assist the Education Department in identifying training needs, creating content, and providing expertise for in-service training to improve team knowledge, performance, and patient care.

• Resolve complex medical policy needs while prioritizing timely patient care.

  • This will entail building strong working relationships and acting as an internal liaison between the Clinical Operations, Patient Access, Patient Care Navigators, and Patient Resources teams as well as working with external providers.

• Have a thorough understanding of and follow Payor Medical Policy Criteria for all new and existing medications.

• Research and understand off-label uses for medications and draft letters of medical necessity citing relevant articles.

• Research and assess multiple specialty medications and diverse medical conditions to assist referring offices with determining appropriate treatments for patients that additionally aligns with the patients' insurance coverage.

• Educate referring provider teams on complex insurance coverage requirements for new and existing medications, working together to find the most favorable option for each patient.

• Assess referred patient charts for safety and appropriateness of prescribed treatment regimen, reporting potential concerns to the clinical operations team.

Additional role responsibilities:

• Consistently demonstrate the Vivo Infusion Mission, Vision, and Culture.

• Assist billing and collections team with diagnosis code review and other tasks needed for appealing claim denials.

• Support and participate in process improvement efforts.

• Provide excellent customer service when communicating with patients, providers, and referring offices.

• Adhere to HIPPA.

Qualifications:

• Licensed Practical or Vocational Nurse (LPN/LVN) or Registered Nurse (RN), required.

• IV certification or Infusion experience, preferred.

• Prior experience working with and a thorough understanding of insurance, required.

• Experience working in a remote setting, preferred.

• Advanced knowledge of infusion procedures and terminology, required.

• Thorough knowledge of potential medical safety concerns for formulary medications, required.

• Minimal travel for transition and education purposes.

• Must have excellent grammatical, written communication, and LMN skills.

• High proficiency in research of complex medical conditions and medically appropriate treatments as well as supporting scientific literature, required.

• Must possess outstanding communication and interpersonal skills, and communicate professionally and effectively with all teams. Must be fluent in written and spoken English.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Work environment and physical demands:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

The employee is frequently required to sit and infrequently required to stand, lift and/or move up to 15 pounds. While performing the duties of this job, the employee is required to sit, stand; walk and talk, and hear. Requires excellent visual dexterity and manual dexterity.

Who We Are:

The Vivo Infusion team is focused on providing patients with the highest quality of care in a comfortable, safe, and convenient setting! Vivo is a national company with locations in 15 states, providing opportunities for growth and advancement as well as competitive benefits that support what matters most to you.

Our highly trained medical professionals are dedicated to delivering a safe, comfortable, and affordable solution for our patients. We offer an array of advanced therapeutics and provide personalized, care for every patient. These treatments are delivered by a highly-skilled, clinical nursing staff and monitored by board-certified advanced practitioners.

Vivo Infusion has received The Gold Seal of Approval® from The Joint Commission.

The Joint Commission Gold Seal of Approval is a nationally recognized distinction voluntarily earned by a select set of healthcare providers.

An organization that achieves The Gold Seal of Approval® shows its commitment to holding itself accountable to a high bar for quality and safety for those they serve.

Learn more about Vivo, by visiting our website: https://vivoinfusion.com/

RECRUITMENT PRIVACY STATEMENT | Notice to All Applicants:

Vivo Infusion posts all open positions on the Careers page of the company website: https://vivoinfusion.com/careers/

Applicants will never be asked to provide personal identification information (e.g., SSN, Driver’s License, Passport) or financial information (e.g., Banking Information) during the application and Interviewing process.

We may request:

• Contact details such as name, address, email address, and phone number.
• Employment history including previous employers and job titles/positions.
• Background information including academic/professional qualifications, job qualifications, education, certifications or licenses, details included in your CV/resume, transcripts, and employment references.
• Nominated references including their name, contact details, employer, and job role.
• Proof of your eligibility to work in the US.
• Desired salary.

If you have any questions or concerns about this Recruitment Privacy Statement or how we handle your personal data, please contact us at 855.478.1528 or emailing Info@VivoInfusion.com.