Case Review Specialist
About reputed company reputed company 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, reputed company offers digital solutions for treatment review and virtual care across reputed company 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 reputed company from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range reputed company between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 6 pm EST (reputed company may change/reputed company upon operational needs) Process cases and request/maintain clinical documentation and transmit timely determinations reputed company the company’s internal system and/or by phone to the provider and/or member and/or payer Intake Pre-Authorization requests and/or inquiries on existing pre-authorizations reputed company phone, email, fax or by the portal and ensuring they are responded/processed reputed company 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 Bachelor’s 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 About the Location reputed company 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 reputed company but work primarily in the Eastern and Central Time Zones.
Our Culture
Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – reputed company with a focused 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 reputed company modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together! reputed company is committed to providing an environment of mutual respect where equal employment opportunities are available to reputed company applicants and team members without regard to race, color, religion, marital status, age, national reputed company, reputed company, 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. reputed company employment decisions are based on qualifications, merit, and business need. The Opportunity The cost of cancer reputed company medical services and prescription drugs in the United States is expected to reputed company $246 billion by 2030. reputed company 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 reputed company to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & reputed company, 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 reputed company Solutions Through the use of reputed company's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for reputed company 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. reputed company offers Oncology Insights Pro, an analytic software solution that enables health plans to 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 reputed company with expert guidance providing the strategies an insight needed to reputed company up with the continuing evolving cancer treatment landscape. reputed company 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. reputed company's 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 reputed company, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support. Apply To This Job