Infusion Case Manager RN

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Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.

We are looking for an Infusion RN to join our Clinical Operations team, supporting the home infusion site of care program. The Infusion RN will conduct medical review of plan participants’ eligibility for home infusion therapy, engage patients directly to discuss transitioning from a facility-based setting to in-home care, and coordinate the full transition of care with the in-network home infusion provider delivering the infusion services.

This role partners cross-functionally with the care management team to ensure a safe, well-coordinated, and cost-effective infusion experience for Lucent Health’s self-insured employer clients.

• Conducts medical review of plan participants to determine clinical eligibility for home infusion therapy based on diagnosis, treatment plan, and plan benefit design.
• Calls patients directly to discuss the clinical and practical benefits of home infusion versus a facility-based setting, addressing questions about safety, convenience, and cost.
• Educates patients and caregivers on the home infusion process, including the role of the in-network home infusion provider who will deliver infusion services in the home.
• Sets up and schedules the initial home infusion appointment with the in-network provider, aligning with the patient’s treatment timeline and clinical urgency.
• Facilitates the transition of care from the patient’s current site of service (e.g., hospital, infusion center, physician’s office) to the in-home setting.
• Verifies that all necessary clinical documentation, physician orders, and payer authorizations are in place prior to initiating the transition.
• Communicates with the in-network home infusion provider to confirm patient readiness, delivery logistics, and nursing visit schedules.
• Monitors patients following transition to home infusion, including therapy tolerance and any adverse events, escalating concerns to the clinical team as needed.
• Identifies and helps resolve barriers to home infusion (e.g., caregiver availability, home environment, authorization delays) in partnership with the care team.
• Conducts holistic patient assessments, develops individualized care plans, and sets measurable goals consistent with benefit plan design.
• Advocates for the patient and maximizes benefit dollars by researching costs of services and in-network resources.
• Evaluates the effectiveness of the care plan on an ongoing basis and documents all eligibility reviews, outreach, and transition activities in a clear, objective, and timely manner.
• Other duties as assigned

• Registered Nurse with a minimum of 5 years Clinical Experience
• Experience in infusion therapy, home infusion, or IV therapy strongly preferred
• Knowledge of home infusion site-of-care transitions and payer/benefit considerations for infusion services
• Credentials such as CRNI (Certified Registered Nurse Infusion), CCM, CRRN, OCN, or other pertinent certifications (preferred)
• Active, unrestricted multi-state RN license
• Excellent written, telephone, and computer skills, with…