Case Review Specialist Atlanta

About OncoHealth

OncoHealth is a leading digital health company dedicated to helping health plans employers providers and patients navigate the physical mental and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.

About the Role

The Case Review Specialist ensures that case documentation is provided by the provider for accurate and timely determinations and communicates with clinical and non-clinical staff to facilitate case discussions.

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)
• Periodic on-call responsibilities having availability during the week to travel to the Atlanta GA office with personal transportation
• Process cases and request / maintain clinical documentation and transmit timely determinations via the companys internal system and / or by phone to the provider and / or member and / or payerincluding mailed-in requests from providers and members
• Intake Pre-Authorization requests and / or inquiries on existing pre-authorizations via phone email fax or by the portal and ensuring they are responded / processed within the established metrics
• Work collaboratively with clinical and non-clinical staff to facilitate case discussions
• Fax intake and labeling on weekends / Holidays as needed

About You

About the 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.

Our Culture

Taking ownershipof quick action critically thinking through the needs and working well with others are key competencies ofteam member leadership is dedicatedtobuilding a culture based onrespect clinical excellence innovation allwithafocused mission of putting patients first!

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. We enjoy being together!

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.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246billionby has enjoyed rapid growth over the past 3 years and seeks smart collaborative people to join its team. We have just under 250 team members so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & McKesson Corporation we remain in an investment and growth mode. This means we are open-minded to how we get the work done now is the perfect time to talk to us!

Our Current Solutions

Through the use ofOncoHealths utilization management system OneUM our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.

OncoHealth offers Oncology Insights Pro ananalytic software solution that enableshealth plansto use data and analytics to improve oncology programs. Using real world data our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018 the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies offer utilization management and formulary advice and development training for staff.

OncoHealths latest offering is Iris a digital telehealth platform that delivers personalized oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology staffed 24X7 and delivered with empathy Iris allows patients to connect with trained oncology experts and receive personalized oncology-specific telehealth support.

Required Experience :

IC

Key Skills

Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling

Employment Type : Full Time

Experience : years

Vacancy : 1