Utilization Review Nurse Consultant – Oncology and Transplant

Remote, USA • Full-time • Posted 2026-05-04

Conduct medical necessity reviews for oncology and transplant-related services, both inpatient and outpatient.
Collaborate with healthcare providers to gather and assess clinical documentation via phone and electronic systems.
Apply evidence-based clinical criteria and guidelines to authorize services or refer cases to Medical Directors when needed.
Navigate multiple computer systems efficiently while maintaining accurate and timely documentation.
Work primarily in a sedentary setting involving extended periods of sitting, talking, listening, and computer use.
Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges
Minimum of 1 year of experience in Oncology and Transplant either in UM, concurrent review, or prior authorization
3+ years of experience in Acute clinical Oncology or Oncology/Transplant
Strong decision-making skills and clinical judgment in independent scenarios
Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms
Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation
1+ years of Managed Care (MCO) preferred
1+ years of experience working in a high-volume clinical call center environment
NCCN (National Comprehensive Cancer Network) guideline experience/exposure
Remote work experience