This position will be in either Deerfield, IL or Westchester, IL
AIM Specialty Health (AIM), a proud member of the WellPoint family of companies, is a leading specialty benefit management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. AIM Specialty Health is committed to making health care services more clinically appropriate, safer and more affordable.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagineThe Oncology Nurse Reviewer Lead (Nurse Reviewer Senior) will lead the clinical screenings of preauthorization request as well as the oncology quality initiative to assess assessing the medical necessity of oncology medical policy, out of network services, and best quality treatment.
The incumbent will be the lead reviewer, responsible for leading a team of Oncology Nurse Reviewers in a call center environment who collaborate with healthcare providers, Oncology Program Manager, and members to promote the most appropriate, highest quality and effective use of oncology solutions to ensure quality member outcomes, and to optimize member benefits. Handles reviews of all levels of complexity, only requiring guidance on new issues where standards have not been developed.
Primary duties may include, but are not limited to:
The successful candidate will have:
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE. M/F/D/V.
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