Clinical Review RN, Oncology AI Review
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Job Description
Clinical Review RN validating AI-driven oncology workflows for Natera, a global cfDNA testing company. Reviewing complex cases, payer policies, and AI classifications.
Responsibilities:
- Review oncology patient records to determine whether cases meet clinical and payer policy requirements
- Serve as an escalation point for complex cases that cannot be accurately classified by AI workflows
- Analyze challenging clinical scenarios, including multiple cancer diagnoses, complex treatment histories, and ambiguous documentation
- Document findings and recommendations in Salesforce, LIMS, and other workflow tools
- Ensure accuracy and consistency of clinical review outcomes
- Audit AI-generated clinical determinations and data classifications
- Evaluate AI performance against established clinical review standards
- Identify errors, trends, and opportunities to improve automation accuracy
- Participate in validation activities for new AI models, workflows, and clinical review processes
- Provide structured feedback to improve future AI performance
- Partner with Product, Engineering, and Data Science teams to improve clinical AI capabilities
- Help define clinical decision logic and requirements for AI-driven workflows
- Translate clinical review findings into actionable automation recommendations
- Support 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
- Evaluate clinical documentation against coverage requirements
- Identify cases requiring additional clinical review or reimbursement support
- Stay current on oncology standards, treatment pathways, and reimbursement trends
Requirements:
- Active RN license (state or compact)
- BSN preferred; ADN with significant oncology experience considered
- 5+ years of oncology nursing experience in inpatient, outpatient, infusion, navigation, utilization review, clinical review, case management, or related settings
- Strong understanding of cancer biology, oncology treatment pathways, disease staging, and patient treatment journeys
- Experience reviewing and interpreting medical records and clinical documentation
- Strong critical thinking and clinical decision-making skills
- Ability to work independently in a fast-paced, evolving environment
- Excellent written communication and documentation skills
- Comfortable working extensively within technology platforms and digital workflows
- Oncology Certified Nurse (OCN) highly preferred
- Experience with payer policies, utilization management, prior authorization, or medical necessity review highly preferred
- Experience supporting AI, automation, clinical decision support systems, or technology-enabled healthcare workflows highly preferred
- Experience using Salesforce, Epic, LIMS, or other healthcare technology platforms highly preferred
- Familiarity with molecular diagnostics, precision medicine, or MRD testing 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 inclusive workplace commitment
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