Clinical Strategy and Practice Lead, Pharmacy Home Infusion Network - CenterWell
Boston, MA
About the Job
Become a part of our caring community and help us put health first
The Clinical Strategy and Practice Lead builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise. The Clinical Strategy and Practice Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
The Clinical Strategy and Practice Lead Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.
+ Delegation Oversight of Home infusion Nursing Vendors and local providers
+ Supervise through qualified vendors, personnel who provide nursing care.
+ Reconciles monthly vendor billing and budgeting through appropriate tools, reporting and data analytics
+ Coordinates with accounting and finances as necessary
+ Holds quarterly business reviews with nursing vendors and as necessary
+ Reviews and updates vendor contracts with procurement as necessary
+ Ensure that the professional standards of community nursing practice are maintained by all nurses providing care.
+ Creates and maintains performance improvement plans
+ Facilitates in the information security agreements
+ Approves and reconciles monthly invoices
+ Fosters external vendor relationships.
+ Facilitate training and credentialing of nursing vendors
+ Understands the regional needs of CWSP patients and the geography of the nursing vendors available
+ Creation of action plans to close geographic gaps
+ Builds and expands nursing vendor contracts or local vendors to meet the business needs
+ Creates internal infrastructure for internal nursing collaborations and vendor relationship as well as delegation oversight of them
+ Works with IRC to develop and execute intracompany agreements, training and many of the delegation oversight listed above
+ Home infusion Therapy Accreditation and Pharmacy accreditation for infusion nursing services, NABP, URAC, ACHC
+ Participate in audits as necessary
+ Build appropriate reporting, policies and procedures, and internal infrastructure to support accreditation requirements
+ Oversight of home infusion reporting for third party payer contracts
+ Monitor the following key functions:
+ Program evaluation
+ Risk Management
+ Utilization Review
+ Patient Care Evaluation
+ Policies and procedures
+ Human resources
+ Environment of care
+ Surveillance, prevention, and control of infection.
+ Prepare Performance Improvement reports and submit to Leadership as required
+ Recommend, obtain approval for, and monitor corrective action to be undertaken if problems are identified.
+ Maintain and adhere to facility procedure and patient care policy manuals.
+ Establish service policies and procedures in compliance with state health statutes and administrative rules, including CDC and OSHA guidelines for safety, standard precautions, and infection control procedures.
+ Directs, plans and coordinates the service activities and staffing performance of professional nursing and auxillary nursing personnel in rendering quality patient care
+ Create policies and procedures for evaluation of infusion nursing personnel.
+ Stays informed about changes in the field of nursing and home infusion
+ Exhibits and maintains knowledge of infusion nursing, pharmacy services, payment practices and overall understanding of infusion business
+ Identifies and helps to resolve gaps between local and best practices
+ Serves and protects the pharmacy by adhering to professional standards, company policies and procedures, federal, state, and local requirements and URAC/ACHC standard of care
+ Create appropriate training for administration of CWSP home infusion drug list
+ Set or adopt policies for, and keep records of criteria for admission to service, case assignments, and case management.
+ Represent the pharmacy in a professional and courteous manner in all interactions with patients.
+ Determine correct resolution to patient complaints; take corrective action, and monitor results.
+ Communicate with billing department to ensure proper billing to insurance companies, contracts, other third party payers and patients for all products and services delivered
+ Participate in surveys conducted by authorized inspection agencies.
+ Participate in committees when requested.
+ Pursue continuing education programs appropriate to job responsibilities.
+ Assist in internal and external audits
+ Opportunity to create and
+ Perform other duties as assigned by supervisor.
Required Qualifications
+ Graduate of an accredited school of nursing and current RN state license in good standing OR a graduate of an accredited school of pharmacy and current RPH/PharmD state license in good standing
+ Minimum 5 years nursing practice or pharmacy practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care
+ Minimum 5 years nursing practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care
+ Minimum 5 years nursing practice or pharmacy practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care
+ Minimum 2 years management experience, proven ability to lead, train and educate staff on new protocols and existing standard operating procedures
+ Previous experience in establishing and maintaining a home infusion nursing network for Specialty pharmacies
+ Clinical expertise in IV therapies with monitoring, skill and knowledge of IV lines and specialty products provided in the home
Preferred Qualifications
+ Effective interpersonal, time management and organizational skills.
+ Excellent oral and written communication, interpersonal, and resource management skills
+ Organizational skills sufficient to maintain consistently accurate records.
+ Ability to recognize and direct information to the appropriate health care provider.
+ Computer skills that include proficiency with spreadsheets, word processing and efficient use of the internet and e-mail.
+ Ability to successfully execute projects and initiatives in cross functional matrixed environment
+ Ability to work with all levels of employees in a fast paced clinical environment and manage complex projects
+ Knowledge accreditation standards relating to home infusion
+ Insurance reimbursement knowledge and health insurance billing experience.
Use your skills to make an impact
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$112,400 - $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CenterWell Specialty Pharmacy: CenterWell Specialty Pharmacy is an online mail-delivery pharmacy, offering therapies for chronic and complex illnesses, along with personalized support. Our team of nurses, pharmacists and specialists help patients manage their treatment by caring for a variety of conditions and increasing access to hard-to-find, limited distribution drugs.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources
The Clinical Strategy and Practice Lead builds strategies for development, engagement, best clinical practices and processes for clinical community within the enterprise. The Clinical Strategy and Practice Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
The Clinical Strategy and Practice Lead Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.
+ Delegation Oversight of Home infusion Nursing Vendors and local providers
+ Supervise through qualified vendors, personnel who provide nursing care.
+ Reconciles monthly vendor billing and budgeting through appropriate tools, reporting and data analytics
+ Coordinates with accounting and finances as necessary
+ Holds quarterly business reviews with nursing vendors and as necessary
+ Reviews and updates vendor contracts with procurement as necessary
+ Ensure that the professional standards of community nursing practice are maintained by all nurses providing care.
+ Creates and maintains performance improvement plans
+ Facilitates in the information security agreements
+ Approves and reconciles monthly invoices
+ Fosters external vendor relationships.
+ Facilitate training and credentialing of nursing vendors
+ Understands the regional needs of CWSP patients and the geography of the nursing vendors available
+ Creation of action plans to close geographic gaps
+ Builds and expands nursing vendor contracts or local vendors to meet the business needs
+ Creates internal infrastructure for internal nursing collaborations and vendor relationship as well as delegation oversight of them
+ Works with IRC to develop and execute intracompany agreements, training and many of the delegation oversight listed above
+ Home infusion Therapy Accreditation and Pharmacy accreditation for infusion nursing services, NABP, URAC, ACHC
+ Participate in audits as necessary
+ Build appropriate reporting, policies and procedures, and internal infrastructure to support accreditation requirements
+ Oversight of home infusion reporting for third party payer contracts
+ Monitor the following key functions:
+ Program evaluation
+ Risk Management
+ Utilization Review
+ Patient Care Evaluation
+ Policies and procedures
+ Human resources
+ Environment of care
+ Surveillance, prevention, and control of infection.
+ Prepare Performance Improvement reports and submit to Leadership as required
+ Recommend, obtain approval for, and monitor corrective action to be undertaken if problems are identified.
+ Maintain and adhere to facility procedure and patient care policy manuals.
+ Establish service policies and procedures in compliance with state health statutes and administrative rules, including CDC and OSHA guidelines for safety, standard precautions, and infection control procedures.
+ Directs, plans and coordinates the service activities and staffing performance of professional nursing and auxillary nursing personnel in rendering quality patient care
+ Create policies and procedures for evaluation of infusion nursing personnel.
+ Stays informed about changes in the field of nursing and home infusion
+ Exhibits and maintains knowledge of infusion nursing, pharmacy services, payment practices and overall understanding of infusion business
+ Identifies and helps to resolve gaps between local and best practices
+ Serves and protects the pharmacy by adhering to professional standards, company policies and procedures, federal, state, and local requirements and URAC/ACHC standard of care
+ Create appropriate training for administration of CWSP home infusion drug list
+ Set or adopt policies for, and keep records of criteria for admission to service, case assignments, and case management.
+ Represent the pharmacy in a professional and courteous manner in all interactions with patients.
+ Determine correct resolution to patient complaints; take corrective action, and monitor results.
+ Communicate with billing department to ensure proper billing to insurance companies, contracts, other third party payers and patients for all products and services delivered
+ Participate in surveys conducted by authorized inspection agencies.
+ Participate in committees when requested.
+ Pursue continuing education programs appropriate to job responsibilities.
+ Assist in internal and external audits
+ Opportunity to create and
+ Perform other duties as assigned by supervisor.
Required Qualifications
+ Graduate of an accredited school of nursing and current RN state license in good standing OR a graduate of an accredited school of pharmacy and current RPH/PharmD state license in good standing
+ Minimum 5 years nursing practice or pharmacy practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care
+ Minimum 5 years nursing practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care
+ Minimum 5 years nursing practice or pharmacy practice in a related specialty such as home infusion or specialty infusion, home health, oncology, IV therapy or critical care
+ Minimum 2 years management experience, proven ability to lead, train and educate staff on new protocols and existing standard operating procedures
+ Previous experience in establishing and maintaining a home infusion nursing network for Specialty pharmacies
+ Clinical expertise in IV therapies with monitoring, skill and knowledge of IV lines and specialty products provided in the home
Preferred Qualifications
+ Effective interpersonal, time management and organizational skills.
+ Excellent oral and written communication, interpersonal, and resource management skills
+ Organizational skills sufficient to maintain consistently accurate records.
+ Ability to recognize and direct information to the appropriate health care provider.
+ Computer skills that include proficiency with spreadsheets, word processing and efficient use of the internet and e-mail.
+ Ability to successfully execute projects and initiatives in cross functional matrixed environment
+ Ability to work with all levels of employees in a fast paced clinical environment and manage complex projects
+ Knowledge accreditation standards relating to home infusion
+ Insurance reimbursement knowledge and health insurance billing experience.
Use your skills to make an impact
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$112,400 - $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CenterWell Specialty Pharmacy: CenterWell Specialty Pharmacy is an online mail-delivery pharmacy, offering therapies for chronic and complex illnesses, along with personalized support. Our team of nurses, pharmacists and specialists help patients manage their treatment by caring for a variety of conditions and increasing access to hard-to-find, limited distribution drugs.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources
Source : CenterWell