Description
Location: This position is located at our Dublin, OH campus with hybrid flexibility. Multistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health.Who we areFounded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization.We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.About the roleThe Registered Nurse (RN) – Transplant Personal Care Guidefacilitates care coordination for a member with the potential for a transplant, including hematologic malignancies and end stage disease processes. The position requires a multidisciplinary, collaborative approach to manage the complexity, financial impact, frequent resource utilization and variable acuity across the transplant continuum. Management begins at referral and follows through pre-transplant care, evaluation, the transplant phase to post-transplant case closure.What you’ll doIdentify and assess members with the potential for solid organ or bone marrow transplant, end stage renal disease and hematologic malignancies. Engage telephonically with eligible members and transplant facility case managers to educate on plan structure related to transplant, facility selection, and travel and lodging reimbursement. Perform post discharge calls. Provide Utilization Management for Transplant listing requests for identified population. Maintain a working knowledge of all benefit plans and know where to access the needed information. Negotiate for services needed if no clear benefit exists or if the services can only be provided out of network. Collaborate with the Stop Loss Carrier and TPA vendors for all Transplant specific language, contracting, and claims payment provisions. Maintain working knowledge of how to secure Transplant Vendor contracts, single case rate agreements, access agreements, and negotiated agreements as required by client plan design. Be a clinical resource for all Quantum Health work groups. Work closely with and provide updates to internal client executives and employer contacts for transplant patients. Maintain contact with the QH clinical staff for transfer of cases when appropriate. Participate in new hire, clinical and pod staff training as needed or appropriate. All other duties as assigned.What you’ll bringLicensure: Active license in good standing as a Registered Nurse (RN) in Ohio required. Education: Bachelor of Science in Nursing (BSN) preferred. Completion of specialized training in Advanced Achievement in Transplant Management (AATMC) or willingness to complete within two years of employment. Experience: 2+ years of clinical experience with direct patient care required; Proven clinical experience with organ and/or bone marrow transplants, preferred. Excellent verbal and written communication skills. Comfortable communicating with members and providers via phone regularly throughout the day. Ability to communicate effectively with members and providers in implementing clinical services; Translate complex clinical concepts for non-clinical audiences. Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.#LI-HW1 #LI-Hybrid
What’s in it for you
Compensation: Competitive base and incentive compensationCoverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!
What you should know
Internal Associates: Already a Healthcare Warrior Apply internally through Jobvite.Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer .Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position.Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.
Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request.
Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @quantum-health.com. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment. If you believe you’ve encountered a recruiting scam, report it to the Federal Trade Commission and your state’s Attorney General.