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Utilization Review Nurse

US Oncology Network-wide Career Opportunities
life insurance, tuition reimbursement, 401(k), retirement plan
7951 East Maplewood Avenue (Show on map)
Jan 17, 2025
Overview

Rocky Mountain Cancer Centers, Colorado's largest and most comprehensive provider of cancer care has an exciting opportunity for a Utilization Review Nurse at our business office in Greenwood Village.

We realize that it sounds cliche but it is true - taking care of cancer patients is a calling. It's much more than a job. Each of us has a unique story that brought us to Rocky Mountain Cancer Centers (RMCC), but those stories usually share common themes of care, compassion, and commitment.

No matter the role each RMCC team member serves in, the goal is the same: to provide the best care possible for each and every one of our patients. Whether we are a nurse holding our patient's hand, or a scheduler on the phone finding an appointment that fits into a patient's schedule, we are deeply connected to our patients and do what we can to help.

Salary range: $8,000-105,000.00

Pay is based on several factors including but not limited to education, work experience, certification, etc. As of the date of this posting, in addition to your salary, RMCC offers the following benefits for this position, subject to eligibility requirements: Health, dental, and vision plans; wellness program; health savings account; flexible spending accounts; 401(k) retirement plan; life insurance, short-term disability insurance; long-term disability insurance, Employee Assistant Program, PTO, holiday pay, and tuition reimbursement.


Responsibilities

Oversees all activities associated with the development and implementation of clinical reviews. Establishes priorities for continuous quality improvement programs; oversees, implements and reinforces the clinical quality standards that have been set by the practice.

Clinical Utilization Review with results of cost-containing measures, enhanced care-coordination and improved patient care:

  • Prospective - completed prior to patient treatment to ensure timely care-coordination with consult note, orders, prior authorization, medical records, scans, labs, and any additional clinical data elements
    • verify the coverage, eligibility for proposed treatment
    • evaluate the level of care needed and the appropriateness of the proposed treatment and which location
  • Concurrent - a review when treatment is underway to track assessments, patient progress and any care-transitions for Stage III & IV patients.

o collect data on a patient's progress, prognosis, and cost

  • Retrospective - takes place after treatments to evaluate effectiveness, appropriateness and outcomes of Stage III & IV patients

-Review, process and audit the medical necessity for patient's chemotherapy treatment and documentation of regimen relative to pathway adeherence.

-Communicate with nursing and medical staff to inform them of restriction or special requirements in accordance with particular insurance plans.

-Provide feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.

-Maintain a good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorization.


Qualifications

Minimum Requirements: Bachelor's prepared Registered Nurse (BSN), Oncology Certification (OCN) preferred.

Critical Skills: Demonstrated leadership, interpersonal and collaboration skills

Ability to prioritize and re-prioritize quickly

Strong organizational and critical thinking skills

Strong verbal and written communication skills

Additional Knowledge/Skills Working computer and internet skills, including an electronic EMR system

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. 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. -Required to lift and assist patients as requested.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment may occur.

Candidates will be required to show proof of being vaccinated against influenza upon commencing employment. Reasonable accommodations will be considered on a case-by-case basis for exemptions to this requirement in accordance with applicable law.

All qualified candidates are required to pass a background check and non-federal drug test (which excludes marijuana) post offer of employment and prior to hire.

We will be accepting applications on an ongoing basis for this position. To apply for this position, start the process by clicking the blue "apply"

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