Description: Oncology Nurse Reviewer - AIM - Glendale 82488 IL , Westchester CA , Glendale IL , Deerfield Job Post Date: 07/15/2014 Employer: WellPoint, Inc Benefits: WellPoint''s Benefits Job Description Oncology Nurse Reviewer This position is located inGlendale, California AIM Specialty Health(AIM), a proud member of the WellPoint family of companies, is a national leader in specialty benefit management. Through an innovative technology platform and steadfast commitment to excellent customer service, AIM promotes the appropriate, safe and cost effective use of clinical services including: oncology, radiology, cardiology, specialty drugs, and sleep medicine. If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as an OncologyNurse Reviewer. Nurses at AIM have a unique opportunity tobalance work and family commitmentsby working aregular, Monday-Friday daytime schedule. We offer a comprehensive benefits package, including medical/dental/vision coverage, generous paid time off, 401(k) with company match, licensure reimbursement and much more. We are seekingOncology Nursesto become a part ofAIM’s new Integrated Oncology Solution. This enhanced oncology management system will help ensure high quality cancer treatment, promoting the most appropriate use of clinical services. This will deliver a comprehensive solution that encourages the use of evidence-based, cost-effective treatment pathways across all tumor types. Oncology Nurse Reviewers will work with AIM physician reviewers, AIM oncologists, and intake specialists as apart of a dedicated clinical review team. They will function in aprofessional, dynamic, entrepreneurial Clinical Operations environmentwhich values a teamwork approach. Nurse Reviewers will be responsible for conducting preauthorization, out of network and appropriateness reviews of treatment plans utilizing appropriate policies, clinical and department guidelines. They will collaborate with healthcare providers and members to ensure that patients are receiving high-quality care and clinically effective cancer treatments to optimize member benefits. Oncology Nurse Reviewers: * Receive preauthorization requests from front-line intake specialists through direct call transfer. * Conduct initial medical necessity clinical screening. * Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conduct initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Verbally notify ordering physician or rendering service provider office of the preauthorization determination decision. * Document the results of the initial clinical review and determination in the precertification computer system. * Request additional clinical information as applicable. * Maintain telephone service standards in accordance with pre-established departmental performance metrics. About AIM Specialty Health AIM Specialty Health (AIM) 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. Our mission is to make healthcare services more clinically appropriate, safer and more affordable. As such, we promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. With over 32 million members covered across 50 states, AIM ensures delivery of the right test at the right time in the right place. We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL as well as Glendale, CA. This position will be available in our modern Westchester and Deerfield, Illinois and Glendale, California contact centers. AIM‘s services include: * Oncology Management programs leveraging AIMs proven specialty benefit platform to drive consistent and effective cancer care through services review along with management of close to 70 oncologic drugs. * Prospective clinical review of outpatient advanced imaging procedures such as CT, MRI, Nuclear Cardiology and PET Scans. * Clinical review for cardiology and specialty pharmacology products and services. * Specialty Drugs programs to provide review for over 142 specialty drugs offering providers an automated drug review process through our provider friendly web portal. * Sleep Management, designed to align the diagnosis and treatment of sleep apnea against clinical guidelines, enhance member access to high value providers and ensure treatment compliance for the dispensing of supplies. Our programs combine clinical excellence, its innovative technology and a commitment to customer service, ensuring the company’s on-going leadership in the rapidly evolving healthcare environment. AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.) A Leading Employer of Choice Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression youd expect from an industry leader. These benefits include: * An array of Health, Dental and Vision Care Insurance plans * Term Life Insurance * Short- and Long-term Disability Insurance * 401(k) Employee Savings Plan with company match * Paid Time Off * Tuition Reimbursement * Tax-advantaged health care and dependent flexible spending plans * Health club reimbursement allowance * Licensure reimbursement for medical professionals Our total rewards package is designed to attract, motivate and retain qualified individuals. Whether you are interested in medical utilization management, nursing, information technology, accounting and finance, marketing or human resources, there may be an opportunity for you at AIM. As an Equal Opportunity/Affirmative Action employer, we are committed to promoting diversity in the workplace. Job Qualifications The qualified candidate will have: * Registered Nurse with a current, valid unrestricted license inCalifornia * Prefer current oncology certification from the Oncology Nursing Certification Corporation. This could be as an oncology certified nurse (OCN®), certified pediatric oncology nurse (CPON®), certified pediatric hematology/oncology nurse (CPHON®), advanced oncology certified nurse (AOCN®), advanced oncology certified nurse practitioner (AOCNP®), advanced oncology clinical nurse specialist (AOCNS®), or certified breast care nurse (CBCN®). * Minimum of three (3) years recent clinical nursing experience in an ambulatory or hospital oncology setting. * Familiarity with managed health care programs including HMO, PPO, and POS * Familiarity with Utilization Management Guidelines preferred * Familiarity with ICD-9 and CPT 4 coding preferred * Previous utilization and/or quality management and/or call center experience helpful * Candidates should have good computer skills and solid typing speed and accuracy 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 atwww.wellpoint.com/careers.EOE. M/F/D/V. Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required). *Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR. *WARNING :Please beware of phishing scams that promote work-at-home opportunities and may also pose as legitimate companies. Please be advised that a WellPoint recruiter will never ask you for a credit card or any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application on our wellpoint.com/careers web site.