- Review authorizations being put together by the chemotherapy authorization team and/or escalated by the team for clinical topics, and provide guidance
- Ensure appropriate matches between authorization regimen requests, diagnoses on record, and submitted documentation to improve chances of first-time approvals and successful reimbursement
- Interface with TOI Oncologists to answer questions related to chemotherapy authorization, address adjustments to regimen orders per protocols, and implement UM Medical Director guidance
- Participate in the processing of physician orders and preparation of prior authorizations for submission, as appropriate and where clinician specialist expertise is needed
- Identify patterns and engage in the collaborative improvement of TOI s authorization processes, and support protocol development and iteration
- Graduation from an accredited Advanced Practice Provider (APP) program, either Physician Assistant (PA) or Nurse Practitioner (NP)
- Active license
- Minimum of 2 years in medical oncology clinical or administrative environment required, 4+ years preferred
- Experience with Utilization Management, Prior Authorizations, and/or Managed Care Operations within a health insurer, medical group, hospital, or other healthcare provider or payer environment
- Experience and comfort with Microsoft Office, EMRs, Practice Management Systems, Internet
- High level of motivation, and passion for helping put together better processes and systems
- Patient- and customer-service orientation
- Effective collaboration, influencing, and teamworking
- Effective oral and written communicator
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Nurse Practitioner, Utilization Clinical Liaison - San Francisco, United States - The Oncology Institute
Description
Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 800 teammates in 60+ clinic locations and growing.
We're hiring a Nurse Practitioner or Physician Assistant for this role
The Utilization Management Clinical Liaison will serve as a critical clinician expert working in partnership with The Oncology Institute s utilization management/chemotherapy prior authorization teams. The specialist will provide clinical guidance to these teams, address and/or oversee authorization escalations, and ensure that appropriate regimens are deployed to achieve high quality care that is consistent with our value-based model, as well as ensure that appropriate authorizations are requested based on payer and clinical diagnosis. The position will also serve in a key liaison role to all TOI s practicing Medical Oncologists, and coordinate with the Medical Director of Utilization Management and clinical and administrative UM leadership. This is a key corporate office role ensuring high quality and efficient treatment for cancer patients in our clinics across the company.
Core Responsibilities:
Requirements:
Salary Range Estimate: $120,000-$140,000
The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine actual salary may include location, your specific skills, how many years of experience you have, and comparison to other employees already in this role.
