[Hiring] Insurance Reviewer - Clinical @The US Oncology Network

Role Description

Comprehensive Cancer Centers of Nevada is seeking a Remote Insurance Reviewer - Clinical (Treatment Prior Authorization Specialist) in Southern Nevada only.

Under general supervision, reviews all orders for prior authorization. Orders can include but are not limited to:

• Diagnostic radiology
• Outside consultations and procedures
• Outside specialty laboratory
• In-house treatment
• Radiation and external procedures

Obtains necessary authorizations, pre-certifications or predeterminations to prevent delays in patient care. Relays denied services and provides next level steps for denial or alternative recommendation to the Provider for ordered testing. Supports and adheres to the US Oncology Compliance Program, including the Code of Ethics and Business Standards.

Qualifications

• High school degree or equivalent.
• Associates degree in Healthcare, LPN state license and registration preferred.
• Minimum three (3) years medical insurance verification, and authorization required.
• Experience using electronic medical record portals.

Requirements

• Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; is regarded as an expert in the technical/functional area; accesses and uses other expert resources when appropriate.
• Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
• Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
• Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
• Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluates products, processes, and service against those standards; manages quality; improves efficiencies.

Benefits

In addition to a great career opportunity, we offer excellent benefits, a team environment, professional development, and the chance to be part of a nationwide network dedicated to fighting the war against cancer.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to:

• Be present at the employee site during regularly scheduled business hours.
• Regularly required to sit or stand and talk or hear.
• Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination.
• Requires standing and walking for extensive periods of time.
• Occasionally lifts and carries items weighing up to 40 lbs.
• Requires corrected vision and hearing to normal range.

Work Environment

The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

Successful candidates will thrive in a fast-paced, rapidly changing environment and have a passion for caring for their patients.