Clinical Reviewer, Nurse (Medical Oncology)

GlobalRemote

Responsibilities

Perform pre-certification utilization reviews of Oncology treatment requests (chemotherapy) Determines medical necessity and appropriateness of services using clinical review criteria.

Qualifications You’ll Need (Required): Registered Nurse with a current, unrestricted license in your state of residence Associates or Bachelor's Degree in Nursing Minimum of three years of direct clinical patient care (acute, inpatient, or critical care setting); strongly prefer direct Oncology experience.
Strong computer skills, including MS Office Suite Strong interpersonal, oral, and written communication skills.
Experience with clinical decision-making criteria sets (NCCH, Clinical Pharmacology) UM/UR experience Clinical
experience in Oncology ONS/ONCC Chemotherapy Immunotherapy Certificate or OCN certification Remote work
experience To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID.
All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment.
The use of artificial intelligence tools during interviews is prohibited and monitored.
Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
experience required for the position and commensurate with
experience of selected individuals, which may vary above and below the stated amounts.

Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Working across specialties and primary care, we seek to connect the fragmented health care system and ensure people receive the same level of care and compassion we would want for our loved ones.
The Clinical Review Nurse serves as a member advocate, expediting care across the continuum and working with the health care delivery team to maintain high-quality, cost-effective care.
Collaborates with physicians and other providers to facilitate the provision of services throughout the health care continuum.
The expected base salary/wage range for this position is $34-38/hr..
As part of our total compensation package, Evolent is proud to offer comprehensive
benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and

If you need reasonable accommodation to access the information provided on this website, please contact recruitingteam@evolent.com for further assistance.

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done.
We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work.
That's one reason why diversity and inclusion are core to our business.
What You’ll Be Doing: Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with the most complex and costly health conditions.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and the autonomy they need to get things done.
We believe people do their best work when they're supported to live their best lives and feel welcome to bring their whole selves to work.
Tasks are performed within the RN scope of practice, under the Medical Director's direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets.
Accurately documents all review rationales and determinations.
Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director.