Oncology Utilization Review Nurse – Clinical Review Preparation

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

📋 Description

• Engage with customers, reviewers, physicians, and management to ensure that completed reports are submitted by the deadlines requested by customers.

• Guarantee that reviewer reports are prompt, comprehensive, clinically precise, and align with both customer expectations and company best practices.

• Provide clients with regular updates on report status.

• Assess physician reports against client and jurisdictional criteria.

• Ensure that clinical justifications support physician conclusions.

• Resolve ambiguous report inquiries with clients.

• Distribute final reports according to the specific requirements of clients.

• Coordinate requests for clarifications and addendums.

• Participate in client phone calls or meetings when reports are questioned.

• Follow up with clients regarding missing referral information.

• Collaborate directly with physicians and office personnel to address client inquiries and obtain clarifications.

• Ensure timely report delivery by following up with physicians.

• Provide verbal or written feedback and clarification requests to physicians.

• Secure physician approval and signatures for final reports.

• Review reports for accuracy of data, as well as spelling, grammar, and punctuation.

• Ensure compliance with state reporting requirements and client-specific formats and handling instructions.

• Offer oversight to team members when necessary.

• Enhance processes to improve turnaround time, peer-to-peer success rates, minimize returned reports, and elevate client satisfaction.

• Approve cases for release to clients.

• Coordinate quality issue reports and new reviewer reports with the VP of Clinical Operations.

• Carry out other duties and special projects as assigned.

⛳️ Requirements

• LPN or RN license is mandatory.

• An Associate’s or Bachelor’s Degree is preferred.

• Previous business experience in a healthcare and/or insurance environment is preferred.

• Outstanding communication skills are essential.

• A clear understanding of company business operations is required.

• Strong critical-thinking skills are necessary.

• Ability to manage time effectively and meet established deadlines.

• Proficient computer skills and typing ability are necessary.

• Ability to provide and support personal internet services is required.

• An uninterrupted internet connection is essential for this work-from-home position.

• Capability to perform necessary lifting, bending, traveling, prolonged sitting, and computer work.

🏝️ Benefits

• Medical, dental, and vision insurance for employees and their families.

• Optional life insurance for employees, spouses, and children.

• Insurance plans for hospital indemnity, critical illness, accident indemnity, and pets.

• Basic life insurance provided at no cost.

• Short-term disability coverage at no charge.

• Long-term disability coverage at no cost.

• Paid time off.

• 401(k) plan with company matching.

• Apple equipment provided for remote workspace.

• Media stipend for remote workspace.

• Remote work arrangement available.