Clinical Review RN, Oncology AI Review

This is a fully remote position, open to applicants in United States.

📋 Description

• Review oncology patient records to assess whether cases fulfill clinical and payer policy criteria.

• Act as an escalation point for intricate cases that cannot be accurately categorized by AI workflows.

• Analyze complex clinical scenarios, such as multiple cancer diagnoses, detailed treatment histories, and unclear documentation.

• Document findings and recommendations utilizing Salesforce, LIMS, and other workflow tools.

• Ensure precision and consistency in clinical review results.

• Audit AI-generated clinical determinations and data classifications.

• Evaluate AI performance against defined clinical review standards.

• Identify errors, trends, and opportunities to enhance automation accuracy.

• Engage in validation activities for new AI models, workflows, and clinical review procedures.

• Provide structured feedback to enhance future AI performance.

• Collaborate with Product, Engineering, and Data Science teams to advance clinical AI capabilities.

• Assist in defining clinical decision logic and requirements for AI-driven workflows.

• Translate clinical review findings into actionable recommendations for automation.

• Support the testing and implementation of AI-enabled solutions.

• Contribute to Natera's oncology clinical intelligence platforms.

• Develop expertise in payer coverage policies relevant to Signatera and oncology testing.

• Assess clinical documentation against coverage requirements.

• Identify cases that necessitate further clinical review or reimbursement assistance.

• Stay updated on oncology standards, treatment pathways, and reimbursement trends.

⛳️ Requirements

• Active RN license (state or compact).

• BSN preferred; ADN with substantial oncology experience will be considered.

• Over 5 years of oncology nursing experience in inpatient, outpatient, infusion, navigation, utilization review, clinical review, case management, or similar settings.

• Strong knowledge of cancer biology, oncology treatment pathways, disease staging, and patient treatment journeys.

• Experience in reviewing and interpreting medical records and clinical documentation.

• Excellent critical thinking and clinical decision-making abilities.

• Capability to work independently in a dynamic, fast-paced environment.

• Outstanding written communication and documentation skills.

• Proficient in working extensively within technology platforms and digital workflows.

• Oncology Certified Nurse (OCN) is highly preferred.

• Experience with payer policies, utilization management, prior authorization, or medical necessity review is highly preferred.

• Experience supporting AI, automation, clinical decision support systems, or technology-enabled healthcare workflows is highly preferred.

• Familiarity with Salesforce, Epic, LIMS, or other healthcare technology platforms is highly preferred.

• Knowledge of molecular diagnostics, precision medicine, or MRD testing is highly preferred.

🏝️ Benefits

• Comprehensive medical, dental, vision, life, and disability plans for eligible employees and their dependents.

• Free testing for employees and their immediate families.

• Fertility care benefits.

• Pregnancy and baby bonding leave.

• 401k benefits.

• Commuter benefits.

• Employee referral program.

• Equal Opportunity Employer and commitment to an inclusive workplace.