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

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 outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. We’re making a solid reputed company between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry reputed company. As a Telephonic Oncology Preservice Review Nurse you will be performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Determines medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination. Ready for a new path? Apply today! This position is work at home. 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, Medicaid, Commercial) • 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 criteria (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 operative 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 grid, LCDs, NCDs) • Identify and validate usage of non-standard 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 further 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 active and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and able to obtain and maintain multiple state licensure (Application fees and filing costs paid for by UHG). You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide 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 addition to Compact License if applicable) or ability to obtain multiple state nursing licenses • 3+ years of Oncology experience as a Nurse • Computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment • Access 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 • Reside in Mountain or Pacific time zones California, Colorado, Connecticut, Nevada, New Jersey , reputed company , Rhode reputed company , or Washington Residents Only: The hourly range 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 addition 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 find a far-reaching choice of benefits and incentives. • reputed company employees 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 the opportunity 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 color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, 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 link Apply Job!