Case Review Specialist

OncoHealth 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 8 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all 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

• Process cases and request/maintain clinical documentation and transmit timely determinations via the company’s internal system and/or by phone to the provider and/or member and/or payer
• Collect and transfer non-clinical data into internal data management system
• Acquire structured clinical data to place into internal data management system
• Contact provider and request medical records as needed
• Process protocols according to client contract turnaround times (TAT)
• Intake Pre-Authorization requests and/or inquiries on existing pre-authorizations via phone, email, fax or by the portal and ensuring they are responded/processed within the established metrics
• Work collaboratively with clinical and non-clinical staff to facilitate case discussions
• Provide clinical staff all necessary records
• Fax CCF’s to providers as needed
• Fax RAD’s to providers as needed
• Assist clinical with Peer-to-Peer calls to providers
• Fax intake and labeling on weekends/Holidays as needed
• Reviewing all protocol request that are received electronically and label accordingly
• Ensure information is received to process protocols

About You

• Bachelor’s Degree or relevant experience preferred
• 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

OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.

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 – all 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 very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!

OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, 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. All employment decisions are based on qualifications, merit, and business need.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth 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 precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & McKesson Corporation, 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 Current Solutions

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all 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.

OncoHealth 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 paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth 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.

OncoHealth'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 empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

Pay: $16.00 per hour