Utilization Review Nurse Consultant – Oncology and Transplant
Job Description:
• Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient.
• Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems.
• Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed.
• Navigate multiple computer systems efficiently while maintaining accurate and timely documentation.
• Work primarily in a sedentary setting involving extended periods of sitting, talking, listening, and computer use.
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.
Requirements:
• Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
• Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization
• 3+ years of experience in Acute clinical Oncology or Oncology/Transplant
• Strong decision-making skills and clinical judgment in independent scenarios
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation
• 1+ years of Managed Care (MCO) preferred
• 1+ years of experience working in a high-volume clinical call center environment
• NCCN (National Comprehensive Cancer Network) guideline experience/exposure
• Remote work experience
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• Many other benefits depending on eligibility
Apply Now
Apply Now
• Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient.
• Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems.
• Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed.
• Navigate multiple computer systems efficiently while maintaining accurate and timely documentation.
• Work primarily in a sedentary setting involving extended periods of sitting, talking, listening, and computer use.
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.
Requirements:
• Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
• Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization
• 3+ years of experience in Acute clinical Oncology or Oncology/Transplant
• Strong decision-making skills and clinical judgment in independent scenarios
• Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation
• 1+ years of Managed Care (MCO) preferred
• 1+ years of experience working in a high-volume clinical call center environment
• NCCN (National Comprehensive Cancer Network) guideline experience/exposure
• Remote work experience
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
• Many other benefits depending on eligibility
Apply Now
Apply Now