RN, Registered Nurse -Oncology Pre-Certification

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost.

About the role

This position is located at our Dublin, OH campus with hybrid flexibility. The Pre-Certification Nurse, Oncology is responsible for reviewing oncology service requests related to clinical trials, chemotherapy, and radiation therapy for enrollees of Quantum Health’s employer groups. This role works to increase the consistency and efficiency of oncology service requests.

Responsibilities

• Review and process all requests for oncology services related to clinical trials, chemotherapy, and radiation.
• Work with Medical Director/Physician reviewer for all requests requiring physician review.
• Communicate with members, providers, facilities, and all internal work groups regarding the outcome of requests.
• Maintain a working knowledge of all clinical processes and workflows, as well as all employer benefit plans and how to access needed information.
• May serve as a Subject Matter Expert (SME) for a clinical process or content area; may participate in educational training with clinical staff regarding oncology nursing services.
• Identify members who may be appropriate for case management services (Complex, High cost, Transplant).
• Identify care coordination opportunities and work with clinical teams to coordinate oncology services.
• All other duties as assigned.

Requirements

• Education: Bachelor’s degree in nursing or closely related field or equivalent experience.
• Experience: Minimum of 2 years of oncology nursing experience.
• License/Certification: Current and active license as a Registered Nurse in the state of Ohio.
• Strong working knowledge of NCCN (National Cancer Comprehensive Network) guidelines.
• Oncology certification preferred.

Skills

• Excellent critical thinking skills.
• Strong interpersonal skills.
• Excellent verbal and written communication skills.
• Self-directed, organized with excellent time management skills.
• Strong administrative/technical skills; comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
• Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.
• Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies.