Clinical Support & Case Review Nurse | Remote | NantHealth
The Clinical Support and Case Review Nurse is a key member of both the Medical Operations and Client Support teams. The purpose of this position is to successfully ensure that all clinical and plan information is collected and thoroughly reviewed in order to present a full clinical picture including diagnosis, stage, pathology and proposed treatment plan for medical office review for cases that do not receive an automated code via the Eviti platform. In addition, the Clinical Support and Case Review Nurse will interact with physicians’ offices and their clinical staff to resolve Eviti reported clinical incidents/questions and perform clinical analysis on those incidents in conjunction with the Eviti Support team. As an initial reviewer, the Clinical Support and Case Review Nurse will never issue a non-certification decision. The Clinical Support and Case Review Nurse will have access to a qualified physician reviewer during standard operation hours to assist in initial clinical review. The physician will be responsible for issuing non-certification determinations. The Clinical Support and Case Review Nurse must be an experienced oncology nurse familiar with evidenced based treatment protocols for a wide variety of cancers. The appropriate candidate will be results-driven, organized, effective at communicating, have excellent troubleshooting skills, and be able to prioritize tasks while working on multiple clinical issues. Responsibilities include, but are not limited to: Review case information in Eviti Customized treatment cases and compare against the submitted diagnosis field and treatment field to validate that the information accurately depicts status of patient and planned treatment Contact physicians’ offices and obtain all necessary information from medical records Follow-up with the submitting office to clarify any inconsistencies between the provided notes andthe submitted diagnosis field and treatment plan Request additional clinical information at the direction of the Oncology Certified NP or MD Monitor progress of report and intervene to ensure timely delivery of product as agreed upon by client Act as a clinical resource for all non-clinical staff to address clinical questions or concerns Respond to customers and support team following a defined support process Identify, research, and resolve customer clinical issues Present a professional image at all times to customers and vendors Work collaboratively with other service delivery areas to provide clients with a superior experience and ensure commitments made to the client are handled appropriately Ability to work flexible hours providing support coverage Education & Experience Requirements: Current Active Unrestricted Registered Nursing License in a state or territory of the United States BSN in Nursing preferred 5 Years Oncology Experience, OCN certification preferred Demonstrated strong attention to detail and documentation Strong computer skills and ability to communicate professionally in writing Required Knowledge, Skills, and Abilities: Strong knowledge of oncology and insurance industry Excellent interpersonal skills, with ability to relate to patients, medical management personnel,office practice and hospital staff Ability to utilize critical thinking skills in order to address clinical needs of oncology patients Ability to strictly adhere to aggressive timelines Proven ability to problem solve and take initiative without needing supervision in a fast-pacedenvironment Experience with Microsoft Office Products Strong customer services orientation The anticipated base salary for applicable remote US-based applicants to this position is below. The specific rate will depend on the successful candidate’s qualifications, prior experience as well as geographic location. $91,200 - $109,000, plus bonus potential. Apply tot his job Apply To this Job