The Oncology Institute · 1 day ago
Oncology Utilization Management Registered Nurse
United States
Full-time
Remote
Mid Level
$80K/yr - $95K/yr
3+ years expThe Oncology Institute is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. As an Oncology Utilization Management RN, you will ensure patients receive timely and appropriate treatment, supporting the high standards of care and the mission of the organization.
Health CareHealth DiagnosticsHome Health CareMedicalOncologyPsychology
Responsibilities
Review cases for laboratory orders and diagnostic studies/procedures to ensure completeness of supporting documentation
Conduct pre-authorization review of services to ensure compliance with medical policy and contracts
With the UM Medical Directors, utilize evidence-based and value-based clinical guidelines to make utilization management decisions
Meet delivery timelines in notifying patients and providers of authorization decisions that are consistent with CMS, NCQA, and any other regulatory requirements
Collaborate with nursing, eligibility, and authorization teams to facilitate continuity of care and optimal patient outcomes
Maintain accurate documentation of utilization and case management activities and report on those regularly
Collaborate with Claims teams to reconcile any issues of improper billing, coding, and potential under/overutilization
Adhere to practice policies and procedures, including compliance with HIPAA privacy and security requirements and all state, federal and plan regulatory mandates
Cooperate with utilization management pharmacy initiatives to implement and promote proprietary preferred pathways
Participate in quality improvement initiatives to enhance processes and service delivery
Participating in process improvement/cost of health care initiatives
Ensure workflow procedures and guidelines are clearly documented and communicated
Interpret or initiate changes in guidelines/policies/procedures
Collaborate across functionally to improve member outcomes
Participate in Regulatory and Internal Audits
Live and exemplify TOI core values, providing outstanding customer service and promoting a positive experience for patients and staff members
Qualification
Required
BSN degree preferred
Minimum of three years of experience in Utilization Management
Current Registered Nurse license in good standing with the appropriate state regulatory body
Oncology experience required
Strong verbal and written communication skills
Ability to work independently, initiate, and successfully complete tasks
Problem-solving aptitude and the ability to navigate challenging situations with sensitivity and professionalism
Excellent analytical and critical thinking skills with attention to detail for decision-making and problem-solving
Mastery of computer skills, including Word, Excel, Power Point and applicable electronic medical software programs
Maintain regular attendance
Ability to effectively present information and respond to questions
Company
The Oncology Institute
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting.
501-1000 employees
H1B Sponsorship
The Oncology Institute has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2022 (1)
Funding
Current Stage
Public CompanyTotal Funding
$291.5MKey Investors
Deerfield
2025-03-24Post Ipo Equity· $16.5M
2021-11-15Post Ipo Equity· $275M
2021-11-15IPO
Leadership Team
Daniel Virnich
Board Member
Jeffrey Langsam
Chief Clinical Officer
Recent News
2026-01-05
2025-12-29
Toi Management, LLC
2025-12-01
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