<p>Job Description</p> <p>Overview</p> <p>Join the Best: Become a Clinical Nurse-Program Coordinator at Riley Hospital for Children!</p> <p>Are you a compassionate and skilled nurse looking for a new challenge? Do you want to be a part of a world-class healthcare team that makes a difference in the lives of children and families? Look no further! Riley Hospital for Children, Indiana's largest and most skilled pediatric system, is seeking a Clinical Nurse-Program Coordinator to join our team! This position works Monday-Friday, day shift.</p> <p>About Us</p> <p>As one of the nation's leading pediatric healthcare networks, we have over 50 locations across Indiana and are ranked among the top hospitals in the nation. Our team of pediatric primary care and specialists work together to deliver comprehensive care to every child, thanks to our expertise in all areas of pediatric health. And, as part of Indiana University Health, we are one of the top 10 sites in the United States for pediatric health research, drawing millions of dollars in biomedical research investments per year.</p> <p>Why Join Us?</p> <p>At IU Health, we offer an unbeatable benefits package that includes:</p> <ul> <li>401 (K) retirement savings with employer match </li><li>Tuition reimbursement </li><li>Employee Assistance Program - Counseling at no cost to you </li><li>Healthy Results - Participation in our team member wellness programs award points that contribute toward a biweekly financial incentive! </li></ul> <p>The Role</p> <p>As the Clinical Nurse Program Coordinator, you will determine medical eligibility of applicants and provides prior authorization of services to families of participants with serious, chronic medical conditions to obtain medical treatment related to the participant's medical condition. This role provides consultation to local agencies and interprets Children's Special Health Care Services (CSHCS) program policies to participants, families, providers and the public.</p> <p>Essential Functions</p> <ul> <li>Evaluates and ensures that all medical records or requests for authorization of payment and specialty care linkages are in compliance with CSHCS rules, and policies are directly related to the eligible medical condition(s). </li><li>Recognizes and updates possible medical diagnoses needs for program participants. </li><li>Explains program in detail to program participants and families regarding requirements, e.g., Indiana resident, notification of changes in address, income, insurance coverage, service coverage or termination and eligibility-related criteria to providers. </li><li>Applies problem-solving skills by recommending medical solutions or giving needed referrals to appropriate agencies. </li><li>Assist participants in transition from CSHCS program due to age or non-eligibility to another program, agency or to any available services. </li><li>Completes timely re-determination of medical eligibility for the CSHCS. </li><li>Attends appeals hearings as needed when a participant is denied an authorization of a service or medical eligibility. </li><li>Obtains and makes changes of insurance information of participants. </li></ul> <p>Qualifications</p> <ul> <li>Requires an Associates of Nursing (ASN). </li><li>Bachelors of Nursing (BSN) preferred. </li><li>Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license. </li><li>Requires that the RN has graduated from a nationally accredited nursing program. </li><li>Requires Basic Life Support certification through the AHA. </li><li>Other advanced life support certifications may be required per unit/department specialty according to patient care policies. </li><li>Care Management and/or Pediatric experience preferred. </li></ul>