Transplant Nurse Advisor

Job not on LinkedIn

🕒 June 10

🇺🇸 United States – Remote

💵 $63.4k - $140k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Tokio Marine HCC

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🤝 B2B

💸 Finance

B2B • Finance

Tokio Marine HCC is a global specialty insurance and reinsurance group that underwrites more than 100 classes of specialty insurance across 180+ countries. The company offers a wide range of commercial products—including accident & health, aviation, casualty, cyber & tech, energy, marine, travel, crop, and transactional risk—serving brokers, enterprises, and program partners. With strong financial ratings (AM Best A++ / Fitch AA- / S&P A+) and a multi-billion dollar premium base, Tokio Marine HCC combines underwriting expertise, program management, and claims services as part of the Tokio Marine Group.

📋 Description

• Under general supervision, manages covered individual transplant needs related to the applicable transplant benefit contract • Provides support in the ongoing development of transplant medical policy • Provides review support to Underwriting and Claims for risk assessment • Perform all intake and initial case set-up for new transplant patient referrals • Conduct due diligence for potential preexisting conditions on new referrals • Communicate with referral source, patient, attending physician, hospital, and transplant team to obtain necessary information for coverage determination as well as quote transplant benefits • Facilitate review of medical information by Medical Director for medical necessity and experimental/investigational determination under the applicable transplant benefit contract • Maintain regular contact with patient, transplant team, and referral source as applicable throughout the transplant benefit period • Facilitate access to transplant network centers • Assess, plan, facilitate, and coordinate the delivery of care for transplant patients • Provide initial and ongoing education about transplantation to the patient • Monitor patient health status and compliance to treatment plan throughout transplant benefit period • Conduct concurrent review while patient hospitalized for transplant related services • Initiate discharge planning as well as medical necessity for home health care and/or skilled nursing needs • Coordinate transplant related medical appointments and make necessary community resource referrals • Communicate with underlying non-transplant benefit administrator when non-transplant services are identified • Document all activities related to transplant case management in the patient record in the excess database • Maintain knowledge base of current transplant technology and advances • Assist in writing transplant clinical guidelines and medical policy • Review disclosed potential transplant candidates and assess for future risk in support of the transplant underwriting process • Review claims to determine transplant versus non-transplant related services as needed • Keep database updated on all transplant center clinical contacts • Travel as requested (minimal) • Other relevant duties and/or special projects as requested

🎯 Requirements

• 4 Year / Bachelors Degree Nursing, a related field, or the equivalent education and/or experience • 5 Years relevant and progressive professional nursing experience in Case Management, preferably in Transplant Case Management • Clinical transplant program management and/or oncology nursing experience preferred • Experience in Transplant Medical Policy a plus • Active, current, and unrestricted state Registered Nurse (RN) License • Broad knowledge base in disease states, progression and management, especially end-stage organ/tissue diseases and their treatment • Ability to communicate assertively, effectively, and collaboratively with management, staff, hospitals, physicians, and patients • Possess and have ability to apply broad knowledge of principles, practices, and procedures • Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy • Exceptional organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously • Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment • Intermediate proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)

🏖️ Benefits

• Comprehensive medical, vision, and dental coverage, with eligibility beginning on your first day of employment • Basic life and disability insurance • 401(k) plan with 6% company match • 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off • Paid parental leave • Access to our award-winning wellness program, including mental health services, fitness network membership, and a complimentary Headspace subscription • Student loan matching program • Employee discount program • An opportunity to do meaningful work and love what you do