Clinical Supervisor, Radiation Oncology Business Services

The primary responsibility of the Clinical Program Manager is to facilitate patient medical clearance using oncology knowledge, clinical judgment, critical thinking skills, and communication skills to assist in resolving difficulties surrounding patient access and authorization.

KEY FUNCTIONS

1. Review clinical case and develop an individualized patient advocacy strategy with the clinical teams for authorization.

• Be aware of the start dates and desires of the clinical team and ensure that the timelines needed by the business office are in step with the clinical team.
• Collaborate with the clinical team so that you understand the rationale for treatment and that rationale can be clearly articulated to the insurance companies.

2. Consistently and accurately utilizes medical acceptance criteria and clinical backgrounds to develop a strong clinical argument for the physician defined care plan.

• Stay up-to-date on recent studies and publications that will strengthen your argument during the appeal process.
• When needed educate your teams on what those arguments are that will help when analyzing benefits.

3. Effectively communicates with the Patient Navigator or Patient Access Specialist to facilitate timely compliance in providing necessary information for authorization and once a patient has been denied services through the authorization process, develops an appeal letter and plan for the insurance companies.

• Ensure that the Navigator understands what is needed from the patient. Coach and develop those conversations with the Navigator so that you can ensure they are correct.
• Pull random calls monthly from your team to ensure compliance. Use the grading tool and report monthly to leadership.

4. Lead teams to get successful determinations for a patient.

• Review monthly your key performance indicators to ensure that timelines are being met.
• Provide leadership a monthly report of your KPIs and an analysis of deficiencies with action plans.

5. Perform yearly performance reviews.

• Perform monthly KPI analysis and provide a 360 review.

6. Knowledgeable on state and federal appeal guidelines and monitors appeal timelines to ensure the best outcome for the patient.

• When there are changes to those guidelines gather information and share with your team to ensure understanding.

7. Huddle with the team daily to ensure patients are meeting timelines

• Address with team members as a team and individually when KPIs are not being met.

8. Coach and develop team members so that understand the workflow.

• Ensure adequate training has been established and identify when more is needed.
• Identify when employees are not meeting goals and work to correct those actions. When needed develop corrective action plans.

9. Meet weekly with clinical staff to ensure that know you are a point of contact.

• Understand their level of desire to do peer-to-peers and ensure that your team knows that and executes that correctly. When needed conduct peer-to-peers as part of the clinical staff.

QUALIFICATIONS

Education

Required: Bachelor's of Science in Nursing or Graduation from an accredited school of dosimetry.

Experience

Required: Four years of clinical nursing experience to include two years radiation oncology experience and one year team lead.

With Dosimetry degree, two years of experience required.

Preferred: Three years of radiation oncology experience. Experience with appeals or health plans.

License/Certification

Required: Current State of Texas Professional Nursing License (RN), or Certified Medical Dosimetrist.

Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR) certification.

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html