Medication Oncology RN - Remote
About the position 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 • Make 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 make medical or clinical determinations • Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical) Requirements • Current, unrestricted RN license in your state of residence • Ability to obtain licensure in other states as needed • 3+ years of radiation 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 • Willing and able to work Tuesday through Saturday 8-5PM in your time zone Nice-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 Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution Apply tot his job Apply tot his job