This role focuses on medical oncology physician review for cases that do not initially meet medical necessity criteria, with a strong emphasis on evidence-based decisions, peer-to-peer discussion, and value-based care. The clinician also supports oncology practice engagement, pathway adoption, and care transformation efforts aimed at improving quality and reducing unwarranted variation. The position blends utilization management with collaboration across clinical, operational, and analytic teams, and includes documentation, training, and quality/compliance work.
Key Responsibilities
- Conduct physician reviews for oncology cases that do not initially meet medical necessity criteria.
- Provide peer-to-peer discussions with requesting oncologists to explain decisions and support value-based practice patterns.
- Support clinical reviewers as a subject matter expert and resource.
- Participate in engagement sessions with oncology practices to promote evidence-based pathways and best practices.
- Collaborate on the design, build, and execution of oncology value initiatives and care transformation efforts.
- Partner with operational and analytic teams to evaluate intervention impact and identify improvement opportunities.
- Document clinical decisions and peer interactions accurately and in a timely manner.
- Participate in audits, training, and inter-rater reliability processes, while maintaining URAC and NCQA alignment.
Required
- MD, DO, or MBBS degree.
- Board certification in Medical Oncology or Pediatric Oncology.
- At least 5 years of post-residency experience.
- Current unrestricted medical license.
- Demonstrated leadership in practice transformation, value-based care, or clinical quality improvement.
- Ability to participate in Medicare/Medicaid programs without sanction or exclusion.
Preferred
- Active clinical practice within the past 2 years.
- Multiple state medical licenses or willingness to obtain them.
Benefits & Perks
- Work/life balance and flexible work approach.
- Autonomy in day-to-day work.
- Potential sign-on bonus.
- Comprehensive benefits, including health insurance, for qualifying employees.
- Support for remote work with required home internet capability.