3419-UM Nurse Reviewer - Oncology
About the Role
We are looking for a Utilization Management (UM) Nurse Reviewer with specific oncology experience to bring deep clinical expertise into our AI-powered prior authorization workflows. This role is responsible for ensuring that our oncology prior authorization workflows reflect evidence-based standards and payer-specific guidelines.
The ideal candidate has extensive oncology background, along with strong utilization management and prior authorization expertise. This role blends clinical judgment with hands-on review of AI outputs to improve accuracy and alignment with payer criteria.
A Day in the Life
- Apply oncology clinical expertise to ensure outputs align with payer requirements, evidence-based guidelines (e.g., NCCN), and coding standards.
- Monitor payer updates and oncology guideline changes; ensure oncology knowledge base remains current.
- Collaborate with product, engineering, and AI teams to translate oncology-specific utilization review requirements into actionable design.
- Test, validate, and refine AI-powered workflows to improve completeness, reduce denials, and ensure usability.
- Provide feedback loops to enhance knowledge base structure, clinical decision support, and automation quality.
- Stay current on oncology payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management.
What You Need
- Registered Nurse (RN) with an active license.
- 3-5 years of experience in oncology utilization management, prior authorization, or medical policy review.
- Strong understanding of payer policies, medical necessity criteria, and oncology authorization workflows.
- Working knowledge of ICD-10 and CPT coding
- Comfort with technology platforms; interest in AI or decision support systems.
- Strong analytical and critical thinking skills with attention to detail.
- Clear communication skills to bridge clinical and technical teams.
Preferred Skills
- Certification in medical coding (e.g., CPC, CCS, CCA, or equivalent).
- Prior experience reviewing or implementing oncology medical policies.
- Familiarity with health informatics or evidence-based guideline development.
- Experience working with AI, automation tools, or clinical decision support systems.
- Ability to work in a fast-paced, innovative environment and contribute to process improvement.
We offer competitive benefits to set you up for success in and outside of work.
Here’s What We Offer
- Generous Paid Time Off: Recharge and relax with 22 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance.
- Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments.
- Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won’t go unnoticed.
- Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.
Innovaccer Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive workplace where all employees feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, medical condition, disability, age, marital status, or veteran status. Innovaccer Inc. participates in the E-Verify program to confirm employment eligibility of all newly hired employees based out of the U.S. and employed by Innovaccer Inc.
For any additional information, please visit the below websites:
Disclaimer:
Innovaccer does not charge fees or require payment from individuals or agencies for securing employment with us. We do not guarantee job spots or engage in any financial transactions related to employment. If you encounter any posts or requests asking for payment or personal information, we strongly advise you to report them immediately to our HR department at [email protected]. Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details.
Average salary estimate
If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.
Talkiatry is hiring licensed therapists in Rhode Island to deliver remote, high-quality telehealth psychotherapy as part of a collaborative, technology-enabled behavioral health team.
Provide compassionate practical nursing care in Baltimore City clinics, offices, and home settings while working under RN or physician direction and supporting public health services.
Join Southcoast Health as a Laboratory Assistant - Phlebotomist to perform phlebotomy, specimen processing, and LIS documentation in a community-focused, not-for-profit health system.
UChicago Medicine is hiring a full-time Night Staff Nurse (RN) for the NICU at Comer Children's Hospital to provide expert neonatal critical care and family-centered support.
UMMC is hiring a licensed Occupational Therapist to deliver assessments, individualized treatment plans, and patient-centered rehabilitation within its downtown Baltimore academic medical center.
GuideStar Eldercare is hiring a licensed Nurse Practitioner to deliver on-site behavioral health and cognitive care to residents at nursing homes and assisted living facilities in the Battle Creek area.
University of Maryland Upper Chesapeake Health is hiring a New Graduate RN for Night Cardiac Telemetry with a $5,000 sign-on bonus to join their Nurse Residency Program.
Experienced GI-focused Registered Nurse needed at Emory's Ambulatory Surgery Center to deliver high-quality endoscopy peri-procedural care and support team operations.
Christian Living Communities seeks an IV-certified Licensed Practical Nurse to deliver hands-on resident care, manage medication administration, maintain care plans, and supervise ancillary staff at their Grand Junction long-term care community.
Lyra Health seeks a licensed-provisional Associate Clinical Social Worker (MSW) to deliver remote, evidence-based clinical care and group facilitation for pediatric and family populations within a collaborative team.
Lyra Health is hiring a licensed telehealth Mental Health Therapist (unrestricted LCSW, LMFT, LPC, PsyD, or PhD) to deliver evidence-based short-term therapy and digital care tools remotely across Virginia.
LifeStance Health is hiring a licensed PMHNP in Plymouth, MN to deliver outpatient medication management and therapy within a flexible, hybrid schedule and comprehensive benefits package.
Northwestern Medicine is hiring an Oncology Nurse Clinician to coordinate multidisciplinary oncology care and provide patient-centered clinical assessment and education at their Geneva, IL location.
🔮
Hi, I'm Risa! Your AI Career Copilot
you, just ask me below!
