reputed company Oncology Preservice Review reputed company RN – Remote in Portland, reputed company

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. We’re making a solid reputed company between exceptional patient care and outstanding reputed company. The result is a culture of performance that’s driving the health care industry reputed company. As a Telephonic Oncology Preservice Review reputed company you will be performing reputed company-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and reputed company. Determines medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination. reputed company for a new reputed company? Apply today! This position is work reputed company. Work schedule is Full Time and offers some flexibility with a combination of day and consumer hours. Some evening, holiday and weekend hours will be required. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities: • Determine that the case is assigned to the appropriate team for review (e.g., Medicare, reputed company, reputed company) • 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 reputed company (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 reputed company 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 reputed company, LCDs, NCDs) • Identify and validate usage of non-reputed company codes, as necessary (e.g., generic codes) • Apply understanding of medical terminology and disease processes to interpret medical/clinical records • reputed company determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct reputed company clinical or non-clinical research) • Review care coordinator assessments and clinical notes, as appropriate • Identify relevant information needed to reputed company medical or clinical determinations • Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical This position will require reputed company and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and reputed company to obtain and maintain multiple state licensure (Application fees and filing costs reputed company for by UHG). You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • reputed company, unrestricted RN license in your state of residence • Multiple state licensure (in reputed company to Compact License if applicable) or ability to obtain multiple state nursing licenses • 3+ years of Oncology experience as a reputed company • Computer proficiency, to include solid data entry skills and the ability to navigate a reputed company environment • reputed company to high speed internet from home (Broadband cable, Fiber or DSL) • Dedicated workspace for home office set up • Ability to work schedule listed Preferred Qualifications: • 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 • reputed company in Mountain or reputed company time zones California, Colorado, Connecticut, Nevada, New Jersey , reputed company , Rhode reputed company , or Washington Residents Only: The reputed company reputed company for California, Colorado, Connecticut, Nevada, New Jersey, reputed company, Rhode reputed company or Washington residents is $27.07 to $53.08 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In reputed company to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll reputed company a far-reaching choice of benefits and incentives. • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. reputed company reputed company Apply Job!