Clinical Nurse Navigator - Rheumatology

Overview Employer Paid Medical, Dental, and Vision Benefits! Min $39.36 Max $63.83 Mon-Fri Days 40 hrs./week Rheumatology Clinic Definition of Position: The Rheumatology RN Navigator provides comprehensive clinical and administrative support for patients with complex autoimmune and inflammatory diseases. This position serves as the primary clinical resource for patients throughout their treatment journey, coordinating care, providing disease-specific education, managing medication therapies, and facilitating communication between patients, providers, pharmacies, infusion centers, insurance companies, and multidisciplinary care teams. A primary responsibility of this role is managing specialty medication prior authorizations and appeals for biologic and targeted therapies, ensuring timely access to medically necessary treatment while minimizing delays in care. The RN Navigator collaborates closely with providers to obtain required clinical documentation, monitor treatment effectiveness, coordinate laboratory monitoring, and ensure compliance with payer requirements. The Rheumatology RN Navigator works under the supervision of the Clinic Nursing Supervisor or Practice Manager while collaborating with physicians, infusion services, pharmacies, referral coordinators, and other healthcare professionals to provide high-quality, patient centered care. Responsibilities Essential Job Functions: Medication & Prior Authorization Management Serve as the clinical lead for specialty medication prior authorizations, including biologics, biosimilars, JAK inhibitors, infusion therapies, and injectable medications. Complete comprehensive prior authorization requests utilizing evidence-based clinical documentation and payer-specific requirements. Prepare, submit, and monitor insurance appeals, peer-to-peer requests, and medical necessity documentation. Coordinate with specialty pharmacies, infusion centers, insurance companies, pharmaceutical manufacturers, and provider offices to ensure timely medication approval and initiation. Track authorization expirations and proactively initiate renewals to prevent interruptions in therapy. Monitor payer formulary changes and recommend appropriate alternatives when needed. Assist patients with enrollment in manufacturer copay assistance and patient assistance programs. Maintain current knowledge of Rheumatology treatment guidelines and specialty medications. Patient Care Coordination Serve as the primary clinical contact for patients with chronic rheumatologic conditions. Coordinate laboratory monitoring required for disease-modifying antirheumatic drugs (DMARDs), biologic therapies, and immunosuppressive medications. Monitor patients for medication effectiveness, adverse reactions, infections, and treatment compliance. Coordinate referrals between rheumatology and primary care, specialty providers, infusion centers, imaging departments, and laboratory services. Ensure continuity of care throughout diagnosis, treatment initiation, medication changes, and long-term disease management. Coordinate infusion scheduling to align with medication approval and treatment timelines. Patient Education Educate patients regarding autoimmune diseases, medication administration, side effects, infection prevention, immunizations, and lifestyle modifications. Provide injection teaching for self-administered biologic medications. Educate patients regarding laboratory monitoring schedules and medication safety. Reinforce provider treatment plans and ensure patient understanding of disease management. Epic & Clinical Communication Manage Epic InBasket messages, patient portal communications, prescription refill requests, and provider messaging. Perform telephone triage utilizing nursing judgment for symptom management and medication-related concerns. Document all clinical interventions accurately and timely within the electronic medical record. Coordinate prescription refills, specialty pharmacy communications, and medication monitoring. Quality & Program Development Monitor prior authorization turnaround times, denial rates, medication access delays, and quality metrics. Develop standardized workflows to improve efficiency of specialty medication approval processes. Collaborate with providers and leadership to optimize medication access and reduce treatment delays. Participate in quality improvement initiatives focused on patient outcomes, medication adherence, and access to care. General Support Performs other related duties as assigned. Position requires flexibility to work evenings, weekends, and holidays as patient care needs and clinic operations dictate May be assigned to work across various medical specialties within the Good Shepherd Outpatient Clinics. Qualifications Qualifications: Education Required: Graduate of an accredited school of professional nursing. Preferred: BSN Licenses/ certifications/ registrations Required: Current, unrestricted Oregon Registered Nurse license. Current BLS certification. Preferred: ACLS (Advanced Cardiac Life Support) certification, Specialty certification relevant to assigned clinic area (e.g., ANCC Rheumatology Nursing Certification (RN-BC)). Experience Required: The ability to work with a culturally diverse population. Preferred: Bilingual and/or English Spanish speaking. Minimum 2 years of clinical nursing experience. Experience with Epic electronic health record system. Knowledge of evidence-based practice and quality improvement methodologies Other Knowledge of computers, phones, and other office equipment. Knowledge in clinical equipment including but not limited to: EKG, vital sign monitoring devices, glucometer, scales, various lab testing equipment, etc. Strong assessment and critical thinking skills Excellent verbal and written communication abilities Proficiency in patient education and health promotion Ability to work independently and prioritize multiple tasks effectively Physical Requirements: The physical and sensory functions described below are essential to the successful performance of this position. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable qualified individuals with disabilities to perform these essential functions. The position requires sufficient auditory ability to detect and respond to various sounds, including patient alarms and verbal communication. Clear and effective communication is essential, as is the ability to interact with patients, families, and healthcare team members. Visual acuity is necessary for observing patient conditions, reading documentation and monitors, and distinguishing colors for clinical purposes, such as identifying medications or safety indicators. Tactile perception is also important for assessing physical characteristics such as temperature, size, shape, or texture during patient care. Motor coordination is required for reaching, grasping, handling, and performing fine motor tasks necessary for the use of medical equipment and procedures. The position also involves occasional stooping, kneeling, crouching, or crawling when assisting patients or accessing equipment. Walking and standing are typically continuous throughout the shift. The role requires the ability to lift to 50 pounds independently and involves frequent pushing, pulling, carrying, or repositioning of objects or patients weighing up to 25 pounds. There may also be occasional lifting or transferring of individuals weighing over 100 pounds, with the expectation that appropriate lifting techniques, mechanical aids, or team assistance will be used to ensure safety. May to sit for long periods of time. Working Conditions: This position is performed primarily in an indoor healthcare environment, such as a hospital, clinic, or long-term care facility. While the work setting is protected from outdoor weather conditions, it may be subject to variable indoor temperatures. The role involves frequent exposure to infectious and contagious diseases, hazardous materials, and medical equipment, with the expectation that all staff follow appropriate safety protocols and utilize personal protective equipment (PPE) as required. The health care environment can be fast-paced and unpredictable, requiring the ability to respond quickly to changing circumstances, including high-pressure or emergency situations. The work setting also involves multiple simultaneous demands and varying levels of noise due to medical equipment, staff activity, and patient needs. 40 Hours USD $39.36/Yr. USD $63.83/Yr. 01-3280 Rheumatology Day