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Utilization Review Nurse Consultant – Oncology and Transplant

ConsultantConsultantFull TimeRemoteJuniorTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Ohio

Posted

29 days ago

Salary

$29 - $62 / hour

Seniority

Junior

Associate Degree1 yr expExperience acceptedEnglish

Job Description

• Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient. • Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems. • Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed. • Navigate multiple computer systems efficiently while maintaining accurate and timely documentation. • Work primarily in a sedentary setting involving extended periods of sitting, talking, listening, and computer use. • Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

Job Requirements

  • Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
  • Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization
  • 3+ years of experience in Acute clinical Oncology or Oncology/Transplant
  • Strong decision-making skills and clinical judgment in independent scenarios
  • Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
  • Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation
  • 1+ years of Managed Care (MCO) preferred
  • 1+ years of experience working in a high-volume clinical call center environment
  • NCCN (National Comprehensive Cancer Network) guideline experience/exposure
  • Remote work experience

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings
  • Tobacco cessation and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access
  • Many other benefits depending on eligibility

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