O pozici
Help us insure it
Tokio Marine HCC is a global industry-leading specialty insurance group, backed by the strength and stability of the Tokio Marine Group. Offering over 100 classes of specialty insurance, we empower clients to pursue opportunities confidently through our “Mind Over Risk” philosophy. More than an insurance company, we are an organization built on innovation, unity, and trust.
At our core, we are Always Advancing, driven by innovation and an entrepreneurial spirit that keeps us moving forward. Our people are Experts in Tomorrow, using curiosity and smart working to anticipate what’s next. With a culture rooted in Reaching Out, we foster genuine collaboration and support, ensuring every individual has the opportunity to succeed and make a difference.
For over 50 years, HCC Life Insurance Company, operating as Tokio Marine HCC – A&H Group, has been at the forefront of medical stop loss insurance. In addition to traditional stop loss, we offer captive and Taft-Hartley stop loss solutions, level funded stop loss, Organ & Tissue Transplant insurance and MedPlus insurance. Tokio Marine HCC – A&H Group is rated A++ (Superior) by A.M. Best Company and benefits from the financial stability of its parent company, Tokio Marine HCC.
Applying our Mind Over Risk philosophy to writing insurance allows our customers to take on opportunity with confidence. That philosophy defines our way of thinking, unites us as a team, and differentiates us from our competitors. We are much more than just an insurance company; we are a good company.
Co budeš dělat
- 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.
- Perform all written communications to patients, physicians, transplant programs, and hospitals.
- 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.
Koho hledáme
- 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
- Experience in Transplant Medical Policy a plus.
- 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,
Benefity
- Equal Opportunity Employer
- TMHCC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, citizenship, color, family or medical care leave, gender identity, genetic information, marital status, medical condition, national origin, physical or mental disability, protected veteran or military status, race, ethnicity, religion, sex (including pregnancy
