Clinical Reviewer, Nurse – Medical Oncology
Evolent
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $32 - $37 per hour
Job Level
Mid-LevelSenior
About the role
- Perform precertification and prior approvals
- Utilization review of outpatient procedures and ancillary services
- Determine medical necessity and appropriateness of services using clinical review criteria
- Document all review determinations and contact providers
- Identify and refer quality issues and potential cases for Care Management
Requirements
- Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license
- High School Diploma or equivalent required
- Minimum of three years of direct clinical patient care
- Minimum of one year of experience with medical management activities in a managed care environment
- Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
- Strong interpersonal, oral and written communication skills
- Basic computer skills
Benefits
- Health insurance benefits
- Work/life balance
- Flexibility to suit work to lives
- Continuing education initiatives
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical decision-making criteriaMillimanInterQualmedical management activitiesutilization reviewprecertificationprior approvalsclinical review criteria
Soft skills
interpersonal skillsoral communicationwritten communication
Certifications
Registered NurseLicensed Practical NurseLicensed Vocational Nurse