[Hiring] Case Review Specialist @OncoHealth

Role Description

The Case Review Specialist—Phone Intake is responsible for ensuring complete, accurate, and timely receipt of submitted documentation to support case review and determination processes. This role serves as a key liaison between providers, health plan, members and internal clinical and non‑clinical teams, facilitating effective communication and timely progression of cases in accordance with established workflows and turnaround time requirements.

Primary Responsibilities

• Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 6 pm EST (Office hours may change/extend upon operational needs).
• Inbound Call Management to include managing a high volume inbound call queue, averaging 60+ inbound calls per day, while maintaining quality, professionalism, and accuracy.
• Serve as the primary point of contact for inbound inquiries related to case status, case intake, documentation requirements, appeals, and next steps.
• Provide clear, accurate, and timely responses to providers and internal stakeholders, ensuring alignment with policies, procedures, and regulatory requirements.
• Accurately document all call interactions, actions taken, and outcomes within the case management system in real time.
• Meet established call response and service level metrics, including:
  • Maintaining an answering service level of 97% or higher.
  • Achieving an average speed of answer (ASA) of less than 30 seconds for at least 80% of answered calls.
• Open, update, and maintain cases in accordance with established workflows and system requirements.
• Review incoming information for completeness and accuracy; identify missing or inconsistent data and initiate appropriate outreach or follow up.
• Coordinate with internal teams (Case Management, Customer Support, Medical Directors, Appeals, Claims, and Operations) to ensure cases move forward efficiently.
• Support appeal related activities by confirming documentation requirements, routing cases appropriately, and monitoring timelines.
• Ensure all cases and call interactions meet quality, compliance, and audit standards.
• Adhere to turnaround time (TAT) requirements and service level agreements (SLAs).
• Apply consistent judgment when escalating issues, identifying risks, or flagging potential delays.
• Maintain patient and provider centric communication at all times.
• Follow documented procedures and workflows while identifying opportunities for process improvement.
• Provide feedback on recurring call drivers, system gaps, or process inefficiencies.
• Support the adoption of updated workflows, scripts, and tools as processes evolve.
• Demonstrate the ability to manage responsibilities independently with minimal oversight once trained.
• Partner effectively with cross functional teams to resolve issues and improve case outcomes.
• Maintain a professional, calm, and solution oriented approach, particularly in high volume or high pressure situations.
• Participate in team meetings, training sessions, and quality reviews as required.

Qualifications

• High school diploma or equivalent required.
• Associate or bachelor’s degree preferred, particularly in: Healthcare Administration, Health Information Management, Business, Administration or a related field. Relevant experience may be considered in lieu of a degree.
• Minimum of 2 years in healthcare operations, utilization management, case management, intake, call center, or a related operational role.
• Strong verbal and written communication skills.
• Ability to manage high call volumes while multitasking across systems.
• High attention to detail with strong documentation practices.
• Ability to work independently while following structured processes.
• Strong problem solving skills and sound judgment.
• Proficiency with case management systems and standard office technology.
• MS Office Suite proficient.

Location

OncoHealth is committed to remote, hybrid or in office work options. The majority of the team will be remote or in hybrid work arrangements with offices in Atlanta, GA and Guaynabo, PR. We are open to employees nationwide but work primarily in the Eastern and Central Time Zones.

Culture

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!

Benefits

• We offer a full benefit package on your first day, along with a company bonus.
• You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter.

Equal Opportunity

OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.