RN - Authorizations & Coordination

Summary of Job Duties The RN will provide coordination and support for Allo Transplant patients throughout the evaluation, authorization, transplant, and post‑transplant process. Collaborates with patients, providers, insurance, case managers, and interdisciplinary teams to facilitate required testing, obtain authorizations, ensure regulatory compliance, and promote continuity of care. Responsibilities Coordinates outside new patient referrals. Ensures that a verification of benefits is ran on every transplant candidate. Reviews verification of benefits, and educates the patient on transplant coverage. Works with Insurance Case Manager to open evaluation for stem cell transplant case. Reviews outside records noting recommendations & works to obtain missing information or testing that is required for pre‑transplant evaluation. Participates in patient financial education of transplant, financial resources, and case manager role. Refers patient to AR Medicaid enrollment or other payer sources. Reviews charts to ensure that all payer required pre‑testing is complete. Gathers all clinical work‑up and submit case for transplant authorization. Notifies the MD, Clinic RN, TC, and BMT global notification email distribution group of the approval and if it is global or not. Opens transplant cases with insurance companies and maintain contact throughout the process, and up to one‑year post transplant. Dependent upon insurance requirements. Once approval is received, follows patient and provide clinical updates, every month or as required by insurance until the patient is 100 days post‑transplant. Follows CMS (Medicare) guidelines and audit patient charts to ensure that our transplants are within Medicare Guidelines. Completes and has physician sign Internal Medicare Guidelines Form, when for Medicare patients. Keeps track of global dates – inform the transplant team of global dates. Appeals insurance denials with clinical documentation, letters of medical necessity if required. Communicates with patients throughout the transplant process keeping them informed of where they are in the approval process. Reports quarterly to the Cancer Institute Stem Cell Transplant QI Meeting: monthly number of referrals, approvals, consults. Participate in meetings regarding reimbursement, contract negotiations, billing, etc. Act as a liaison between inpatient case management and social work and outpatient social worker. Maintain open communication on all transplant patients with insurance case managers. Notifying them if patient is referred for a 2nd opinion, or to OSH for transplant, or that patient is no longer a candidate for transplant. Reviews National Marrow Donor Program invoices. Determine what donor charges are covered by an NMDP grant. Notify Donor coordinator of when appropriate to ask for NMDP grants. Submit paperwork for grants and keep accurate record of all grants. Works with billing department to insure all grant moneys are appropriate, and if not work with them to insure refunds are issued. Follows SOP Guidelines. Stays current with trends in the industry by referencing of professional literature or publications, including Web‑based information. Must stay up to date with frequent insurance company changes and help providers and patients understand when the changes affect their care/treatment plan. Perform other duties as needed. Minimum Qualifications Bachelor's Degree, Associate's Degree, or Diploma RN, with Major: Registered Nurse. Minimum of 3 years of RN experience Valid Arkansas Registered Nursing License Current BLS Preferred Qualifications Case Management experience, 5 years or more CCM or other Oncology related National Nursing Certification Oncology, Stem Cell Transplant Physical Requirements Stand: Frequently Sit: Frequently Walk: Occasionally Bend, crawl, crouch, kneel, stoop or reach overhead: Frequently Lift and carry weight: 25 lbs Push and pull weight: 25 lbs Use hands to touch, handle or feel: Frequently Talk: Continuously Hear: Continuously Taste or smell: Occasionally Read, concentrate, think analytically: Continuously Physical Environment: Inside Medical Facility Environment Salary Information Commensurate with education and experience Required Documents to Apply License or Certificate (see special instructions for submission), List of three Professional References (name, email, business title), Resume Optional Documents Proof of Veteran Status Benefits Eligibility Yes Pre‑employment Screening Requirements Annual TB Screening, Criminal Background Check, Substance Abuse Testing Closing Date 06/24/2026 Type of Position Clinical Staff - Nursing Job Type Regular Sponsored No Institution University of Arkansas for Medical Sciences Department ICE | CORE PA Cancer Medical Authorization EEO Statement The University of Arkansas is an equal opportunity institution. The University does not discriminate in its education programs or activities (including in admission and employment) on the basis of any category or status protected by law, including age, race, color, national origin, disability, religion, protected veteran status, military service, genetic information, sex, sexual preference, or pregnancy. Questions or concerns about the application of Title IX, which prohibits discrimination on the basis of sex, may be sent to the University's Title IX Coordinator and to the U.S. Department of Education Office for Civil Rights. Legal Authority Persons must have proof of legal authority to work in the United States on the first day of employment. Public Disclosure All application information is subject to public disclosure under the Arkansas Freedom of Information Act. Recruitment Contact Please contact View email address on click.appcast.io for any recruiting related questions. #J-18808-Ljbffr