The job below is no longer available.
You might also like
in Westchester, IL
$18est. per hour Residential Home Health and Hospice • 3h agoJust posted Urgently hiring 14.8 mi Use left and right arrow keys to navigate
$90,000Verified per year Aim Transportation Solutions • 6d agoUrgently hiring 6.6 mi Use left and right arrow keys to navigate- $90,000
Verified per year Aim Transportation Solutions • 6d agoUrgently hiring 9.6 mi Use left and right arrow keys to navigate - $30
Verified per hour KLDiscovery • 6h agoUrgently hiring 13.5 mi Use left and right arrow keys to navigate - $39
est. per hour Lincolnwood Place - Senior Lifestyle • 1h agoUrgently hiring 13.4 mi Use left and right arrow keys to navigate
Oncology Nurse Reviewer - AIM - Glendale 100549
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Westchester, Illinois |
About this job
Job Description
This position is located in Glendale, California
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as an Oncology Nurse Reviewer.
Nurses at AIM have a unique opportunity to balance work and family commitments by working a regular, Monday-Friday daytime schedule . We offer a comprehensive benefits package, including medical/dental/vision coverage, generous paid time off, 401(k) with company match, licensure reimbursement and much more.
We are seeking Oncology Nurses to become a part of AIM's new Integrated Oncology Solution . This enhanced oncology management system will help ensure high quality cancer treatment, promoting the most appropriate use of clinical services. This will deliver a comprehensive solution that encourages the use of evidence-based, cost-effective treatment pathways across all tumor types.
Oncology Nurse Reviewers will work with AIM physician reviewers, AIM oncologists, and intake specialists as a part of a dedicated clinical review team . They will function in a professional, dynamic, entrepreneurial Clinical Operations environment which values a teamwork approach.
Nurse Reviewers will be responsible for conducting preauthorization, out of network and appropriateness reviews of treatment plans utilizing appropriate policies, clinical and department guidelines. They will collaborate with healthcare providers and members to ensure that patients are receiving high-quality care and clinically effective cancer treatments to optimize member benefits.
Oncology Nurse Reviewers:
Receive preauthorization requests from front-line intake specialists through direct call transfer. Conduct initial medical necessity clinical screening. Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. Conduct initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. Verbally notify ordering physician or rendering service provider office of the preauthorization determination decision. Document the results of the initial clinical review and determination in the precertification computer system. Request additional clinical information as applicable. Maintain telephone service standards in accordance with pre-established departmental performance metrics.
About AIM Specialty Health
AIM Specialty Health (AIM) is a leading specialty benefit management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. Our mission is to make healthcare services more clinically appropriate, safer and more affordable. As such, we promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. With over 32 million members covered across 50 states, AIM ensures delivery of the right test at the right time in the right place.
We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL as well as Glendale, CA.
AIM's services include:
Oncology Management programs leveraging AIM's proven specialty benefit platform to drive consistent and effective cancer care through services review along with management of close to 70 oncologic drugs. Prospective clinical review of outpatient advanced imaging procedures such as CT, MRI, Nuclear Cardiology and PET Scans. Clinical review for cardiology and specialty pharmacology products and services. Specialty Drugs programs to provide review for over 142 specialty drugs offering providers an automated drug review process through our provider friendly web portal. Sleep Management, designed to align the diagnosis and treatment of sleep apnea against clinical guidelines, enhance member access to high value providers and ensure treatment compliance for the dispensing of supplies.
Our programs combine clinical excellence, its innovative technology and a commitment to customer service, ensuring the company's on-going leadership in the rapidly evolving healthcare environment.
AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)
.
Qualifications
The qualified candidate will have:
Registered Nurse with a current, valid unrestricted license in California Prefer current oncology certification from the Oncology Nursing Certification Corporation. This could be as an oncology certified nurse (OCN ), certified pediatric oncology nurse (CPON ), certified pediatric hematology/oncology nurse (CPHON ), advanced oncology certified nurse (AOCN), advanced oncology certified nurse practitioner (AOCNP ), advanced oncology clinical nurse specialist (AOCNS ), or certified breast care nurse (CBCN ). Minimum of three (3) years recent clinical nursing experience in an ambulatory or hospital oncology setting. Familiarity with managed health care programs including HMO, PPO, and POS Familiarity with Utilization Management Guidelines preferred Familiarity with ICD-9 and CPT 4 coding preferred Previous utilization and/or quality management and/or call center experience helpful Candidates should have good computer skills and solid typing speed and accuracy Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
..
This position is located in Glendale, California
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as an Oncology Nurse Reviewer.
Nurses at AIM have a unique opportunity to balance work and family commitments by working a regular, Monday-Friday daytime schedule . We offer a comprehensive benefits package, including medical/dental/vision coverage, generous paid time off, 401(k) with company match, licensure reimbursement and much more.
We are seeking Oncology Nurses to become a part of AIM's new Integrated Oncology Solution . This enhanced oncology management system will help ensure high quality cancer treatment, promoting the most appropriate use of clinical services. This will deliver a comprehensive solution that encourages the use of evidence-based, cost-effective treatment pathways across all tumor types.
Oncology Nurse Reviewers will work with AIM physician reviewers, AIM oncologists, and intake specialists as a part of a dedicated clinical review team . They will function in a professional, dynamic, entrepreneurial Clinical Operations environment which values a teamwork approach.
Nurse Reviewers will be responsible for conducting preauthorization, out of network and appropriateness reviews of treatment plans utilizing appropriate policies, clinical and department guidelines. They will collaborate with healthcare providers and members to ensure that patients are receiving high-quality care and clinically effective cancer treatments to optimize member benefits.
Oncology Nurse Reviewers:
Receive preauthorization requests from front-line intake specialists through direct call transfer. Conduct initial medical necessity clinical screening. Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. Conduct initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. Verbally notify ordering physician or rendering service provider office of the preauthorization determination decision. Document the results of the initial clinical review and determination in the precertification computer system. Request additional clinical information as applicable. Maintain telephone service standards in accordance with pre-established departmental performance metrics.
About AIM Specialty Health
AIM Specialty Health (AIM) is a leading specialty benefit management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. Our mission is to make healthcare services more clinically appropriate, safer and more affordable. As such, we promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. With over 32 million members covered across 50 states, AIM ensures delivery of the right test at the right time in the right place.
We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL as well as Glendale, CA.
AIM's services include:
Oncology Management programs leveraging AIM's proven specialty benefit platform to drive consistent and effective cancer care through services review along with management of close to 70 oncologic drugs. Prospective clinical review of outpatient advanced imaging procedures such as CT, MRI, Nuclear Cardiology and PET Scans. Clinical review for cardiology and specialty pharmacology products and services. Specialty Drugs programs to provide review for over 142 specialty drugs offering providers an automated drug review process through our provider friendly web portal. Sleep Management, designed to align the diagnosis and treatment of sleep apnea against clinical guidelines, enhance member access to high value providers and ensure treatment compliance for the dispensing of supplies.
Our programs combine clinical excellence, its innovative technology and a commitment to customer service, ensuring the company's on-going leadership in the rapidly evolving healthcare environment.
AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)
.
Qualifications
The qualified candidate will have:
Registered Nurse with a current, valid unrestricted license in California Prefer current oncology certification from the Oncology Nursing Certification Corporation. This could be as an oncology certified nurse (OCN ), certified pediatric oncology nurse (CPON ), certified pediatric hematology/oncology nurse (CPHON ), advanced oncology certified nurse (AOCN), advanced oncology certified nurse practitioner (AOCNP ), advanced oncology clinical nurse specialist (AOCNS ), or certified breast care nurse (CBCN ). Minimum of three (3) years recent clinical nursing experience in an ambulatory or hospital oncology setting. Familiarity with managed health care programs including HMO, PPO, and POS Familiarity with Utilization Management Guidelines preferred Familiarity with ICD-9 and CPT 4 coding preferred Previous utilization and/or quality management and/or call center experience helpful Candidates should have good computer skills and solid typing speed and accuracy Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
..