-
Overview:

The primary purpose of the Clinical Liaison Specialist position is to facilitate relations between The University of Texas M. D. Anderson Cancer Center's (MDACC) and health plans, providers, utilization review/case managers, payors and other persons or entities to coordinate access to care for patients covered by a non-contracted plan or payor. Key FunctionsNegotiates and secures spot agreements for patients accessing care under a non-contracted payor or plan, receiving services at satellite facilities and/or other facilities for which MDACC has some ownership/control.Collaborates with the clinical (case managers, medical directors, etc.) and contracting representatives of outside organizations to facilitate communication with MDACC clinical team regarding the patient's clinical status and available therapies offered by MDACC.Assesses the clinical level of care and works with the applicable plan or payor to negotiate spot agreements for patients covered under a contracted managed care agreement or non-contracted payor when patient requires a service or level of care not covered by agreement or not normally provided by MDACC.Maintains the Spot Database and develops/generates reports annually and/or on an ad hoc basic specific to the spot patient population.Routinely provides feedback regarding utilization trends and/or issues identified with the various non-contracted plans and payors to assist with ongoing strategic decisions regarding such relationships and continued access to care.Serves as an internal resource and provides education on as needed basis to MDACC staff throughout the institution regarding managed care programs, processes and policies to assist with the front-end coordination of care.

Job Description-Requirements:

EDUCATIONRequired:
Graduation from an accredited school of professional nursing.
Preferred:

Bachelor's of Science in Nursing. EXPERIENCERequired:
Five years of experience as a registered nurse to include two years of medical administrative management experience.
Preferred:

Experience working with outside primary/specialty care physicians, case/utilization review managers and medical directors from managed care companies. One year of experience at MDACC.
LICENSURE/CERTIFICATION:

Required:
Current State of Texas Professional Nursing license (RN)
WORK CONDITIONS:

Office environment.