Clinical Reviewer, Nurse – Medical Oncology
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Job Description
Clinical Reviewer, Nurse responsible for performing precertification and prior approvals for Oncology patients. Ensuring the provision of quality care through effective utilization reviews and collaboration with healthcare professionals.
Responsibilities:
- Perform pre-certification utilization reviews of Oncology treatment requests (chemotherapy)
- Determine medical necessity and appropriateness of services using clinical review criteria
- Accurately document all review rationales and determinations
- Appropriately identify and refer cases that do not meet established clinical criteria to the Medical Director
- Collaborate with physicians and other providers to facilitate the provision of services throughout the health care continuum
- Communicate appropriate information to other staff members as necessary/required
Requirements:
- Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license in your state of residence
- High School Diploma or equivalent required
- Minimum of three years of direct clinical patient care (acute, inpatient, or critical care setting); strongly prefer direct Oncology experience
- Strong computer skills, including MS Office Suite
- Strong interpersonal, oral, and written communication skills
- Availability for 9 AM-6 PM Monday through Friday shift with weekend & holiday rotation
Benefits:
- Health insurance benefits
- Comprehensive benefits package
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