Oncology Preservice Review Nurse RN - Remote

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About the position

Responsibilities

  • Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial)
  • Validate that cases/requests for services require additional research
  • Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources)
  • Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited)
  • Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity)
  • Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports)
  • Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)
  • Review and validate diagnostic/procedure/service codes to ensure their relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state grid, LCDs, NCDs)
  • Identify and validate usage of non-standard codes, as necessary (e.g., generic codes)
  • Apply understanding of medical terminology and disease processes to interpret medical/clinical records
  • Make determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct further clinical or non-clinical research)
  • Review care coordinator assessments and clinical notes, as appropriate
  • Identify relevant information needed to make medical or clinical determinations
  • Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical)

Requirements

  • Current, unrestricted RN license in your state of residence
  • Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses
  • 3+ years of Oncology experience as a Nurse
  • Computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment
  • Access to high speed internet from home (Broadband cable, Fiber or DSL)
  • Dedicated workspace for home office set up
  • Ability to work schedule listed

Nice-to-haves

  • OCN Certification
  • Chemo/Bio Certification
  • Certified Case Manager (CCM)
  • Chemo infusion experience
  • ICD Coding experience or solid knowledge of codes
  • NCCN experience
  • Background in preservice review/utilization review/utilization management
  • Reside in Mountain or Pacific time zones

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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