Oncology Preservice Review reputed company RN
Oncology Preservice Review reputed company RN - Remote
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September 6, 2025
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About the position
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)
Requirements
- 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
reputed company-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
- reputed company in Mountain or reputed company time zones
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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