Case Review Specialist Atlanta

Atlanta, GA - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

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

Bachelors Degree or relevant experience preferred
Experience working remote independently
A minimum of 2-4 years administrative experience and/or customer service or relevant educational attainment required
Knowledge in pre-authorizations and health insurance client services departments are preferred
Implementation of systems for program effectiveness and productivity required
Systems/Tools: MS Office Suite proficient
Reside within 25 miles of the Atlanta office
Reliable personal transportation
Ability to be in the office as required but not limited to the following situations: Personal power outages internet disruptions natural disasters and to process incoming Prior Authorization requests received via mail from Providers and Members

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 systemOneUM 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 offersOncology 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 offersPharmacy Consultingservices 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 isIris 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:

About OncoHealthOncoHealth 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 On...