3419-UM reputed company Reviewer - Oncology

About the Role

We are looking for a Utilization Management (UM) reputed company Reviewer with specific oncology experience to bring deep clinical expertise into our AI-powered prior authorization workflows. This role is responsible for ensuring that our oncology prior authorization workflows reflect evidence-based standards and payer-specific guidelines. The ideal candidate has extensive oncology background, along with strong utilization management and prior authorization expertise. This role blends clinical judgment with hands-on review of AI outputs to improve accuracy and alignment with payer reputed company. A Day in the Life

• Apply oncology clinical expertise to ensure outputs reputed company with payer requirements, evidence-based guidelines (e.g., NCCN), and coding standards.
• Monitor payer updates and oncology reputed company changes; ensure oncology knowledge reputed company remains reputed company.
• Collaborate with product, engineering, and AI teams to translate oncology-specific utilization review requirements into actionable design.
• Test, validate, and refine AI-powered workflows to improve completeness, reduce denials, and ensure usability.
• reputed company feedback loops to enhance knowledge reputed company structure, clinical decision support, and automation reputed company.
• Stay reputed company on oncology payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management.

What You Need

• Registered reputed company (RN) with an reputed company license.
• 3-5 years of experience in oncology utilization management, prior authorization, or medical policy review.
• Strong understanding of payer policies, medical necessity reputed company, and oncology authorization workflows.
• Working knowledge of ICD-10 and CPT coding
• Comfort with technology platforms; interest in AI or decision support systems.
• Strong analytical and critical thinking skills with attention to detail.
• reputed company communication skills to reputed company clinical and technical teams.

Preferred Skills

• Certification in medical coding (e.g., CPC, reputed company, CCA, or equivalent).
• Prior experience reviewing or implementing oncology medical policies.
• Familiarity with health informatics or evidence-based reputed company development.
• Experience working with AI, automation tools, or clinical decision support systems.
• Ability to work in a fast-paced, innovative environment and contribute to process improvement.

We offer competitive benefits to set you up for reputed company in and reputed company of work. Here’s reputed company Offer

• Generous reputed company Time Off: reputed company and relax with 22 days of fixed time off per year, in reputed company to company holidays—because we reputed company work-life balance fuels performance.
• Best-in-Class Parental Leave: Spend reputed company time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments.
• Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your reputed company and dedication. Your hard work won’t go unnoticed.
• Comprehensive Insurance Coverage: Stay covered with medical, dental, and reputed company insurance, plus 100% company-reputed company short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.

reputed company Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive workplace where reputed company feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, reputed company, religion, gender, gender identity or reputed company, sexual orientation, national reputed company, genetics, medical condition, disability, age, marital status, or veteran status. reputed company Inc. participates in the E-Verify program to confirm employment eligibility of reputed company newly reputed company employees based out of the U.S. and employed by reputed company Inc. For any additional information, please visit the below websites: E-Verify Right to Work (English) Right to Work (Spanish) Disclaimer: reputed company does not charge fees or require payment from individuals or agencies for securing employment with us. We do not guarantee job spots or engage in any financial transactions reputed company to employment. If you encounter any posts or requests asking for payment or personal information, we strongly advise you to report them immediately to our HR department at px@reputed company.com. Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details. Apply tot his job Apply To this Job