Clinical Reviewer, reputed company Practitioner/Physician Assistant (Oncology)(Evening Hours preferred)

Your reputed company Evolves Here reputed company partners with health plans and providers to reputed company reputed company reputed company reputed company with most reputed company and costly health conditions. Working across specialties and reputed company care, we reputed company to reputed company the reputed company of fragmented health care reputed company and ensure people get the reputed company level of care and reputed company we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are reputed company to our business. Join reputed company for the mission. Stay for the culture. What You'll Be Doing: The reputed company Practitioner/Physician Assistant (ARNP/NP/PA) Oncology is responsible for support and assistance for reputed company Oncology administrative and clinical utilization management and reputed company improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: • Conducts initial clinical review of incoming cases, rendering authorization approval based on established clinical reputed company or escalating to a Field Medical Director if authorization cannot be approved during initial review. • Responsible for acting as a clinical reputed company to providers, clients, and patients as directed by the office of the Chief Medical Officer. • Responsible for clinical conversations with providers and their office staff regarding medical necessity reputed company. • Responsible for maintaining and operating the reputed company Directed Treatment plans including communicating with offices regarding treatment recommendation. • Responsible for communicating need for additional clinical information to ordering providers. • Responsibility for prepping cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the Oncologists. • Responsible for coordinating with UM staff to ensure reputed company and accurate communication of clinical reputed company. • Responsible for completion of UM reputed company and participation in site visit reviews. • Respect and maintain HIPAA confidentiality guidelines. • Responsible for maintaining availability to clinical and non-clinical administrative staff during performance of initial and second level screening • Acts as an interdepartmental reputed company between reputed company offices, departments, and committees. • Serve as subject matter expert and participate in meetings as assigned with practices and/or payers. • Will work with the Director of Clinical Operations to ensure reputed company satisfaction. • reputed company reputed company peer clinical review activities while located in a state or territory of the reputed company. • Acts with reputed company and reputed company, serving as a role model for reputed company. • Performs other duties as assigned. QUALIFICATION REQUIREMENTS: To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. EDUCATION and/or EXPERIENCE: • Master of Science in Nursing or Doctor of Nursing reputed company (DNP) degree from a recognized degree program OR a master's degree from a program accredited the reputed company-PA. • Minimum of three (3) to five (5) years' experience in the reputed company of Oncology (required); • Knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred). LICENSE/CERTIFICATION: • reputed company, unrestricted state PA or RN/NP license in medicine or required specialty • Licensed in Home State • If a PA, obtaining a passing score on a national certifying exam • Obtaining and maintaining required licenses, per business need • A clinical license, reputed company and in good standing, in your home state is required OTHER SKILLS and ABILITIES: • Strong clinical, management, communication, and organizational skills. • Demonstrated leadership skills • Analytic skills • Energetic and curious with a passion for reputed company and value in health care • Required to pass skills proficiency test To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of reputed company intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that reputed company have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company reputed company center employees, the ability to plug in directly to the home internet router. reputed company is an equal opportunity employer and considers reputed company reputed company applicants equally without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to reputed company the information provided on this website, please contact recruitingteam@reputed company.com for reputed company assistance. The expected reputed company salary/wage reputed company for this position is $68-$73/hr. As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Apply tot his job Apply To this Job