Qualifications
Qualified Candidates will have:Current unrestricted medical license(s) to practice medicine as a Doctor of Medicine or Doctor of Osteopathic Medicine in the appropriate state Board Certification in Medical Oncology or Hematology by American Board of Internal Medicine.Demonstrated knowledge of current practice standards in specialtyStrong oral communication and interpersonal skillsComputer literacy with the ability to learn new applicationsAbility to multi-taskAbility to work both independently and in a team environmentAbility to work in a dynamic, fast-paced environment
Successful candidates will:
Perform physician-level case review, following initial nurse review, of oncology and high-tech diagnostic imaging requests. Determine medical necessity of requests using Clinical Appropriateness Guidelines and client-specific health plan medical policyConduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.Suggest alternative treatments, studies and sites of care to ordering providers when appropriateProvide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered oncology and diagnostic imagingmodalities.Actively participate in physician team meetings.Demonstrate and maintain knowledge of relevant policies and regulations pertaining to medical oncology and imaging modalities.Actively participate in groups that develop, revise and enhance clinical appropriateness guidelinesPerform first level provider appeals of coverage decisions.Obtain additional state licensure based upon state regulations and health plan needsAdhere to all Specialty Health protocols, policies, and procedures
Qualified Candidates will have:Current unrestricted medical license(s) to practice medicine as a Doctor of Medicine or Doctor of Osteopathic Medicine in the appropriate state Board Certification in Medical Oncology or Hematology by American Board of Internal Medicine.Demonstrated knowledge of current practice standards in specialtyStrong oral communication and interpersonal skillsComputer literacy with the ability to learn new applicationsAbility to multi-taskAbility to work both independently and in a team environmentAbility to work in a dynamic, fast-paced environment
Successful candidates will:
Perform physician-level case review, following initial nurse review, of oncology and high-tech diagnostic imaging requests. Determine medical necessity of requests using Clinical Appropriateness Guidelines and client-specific health plan medical policyConduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.Suggest alternative treatments, studies and sites of care to ordering providers when appropriateProvide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered oncology and diagnostic imagingmodalities.Actively participate in physician team meetings.Demonstrate and maintain knowledge of relevant policies and regulations pertaining to medical oncology and imaging modalities.Actively participate in groups that develop, revise and enhance clinical appropriateness guidelinesPerform first level provider appeals of coverage decisions.Obtain additional state licensure based upon state regulations and health plan needsAdhere to all Specialty Health protocols, policies, and procedures