Who we are

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Oncology Pre-Certification Nurse is responsible for reviewing prior authorizations related to oncology services for enrollees of Quantum Health’s employer groups. This position will work to increase the consistency and efficiency of oncology service requests. Prior authorizations related to oncology services.

Location: This position is located at our Dublin, OH campus with hybrid flexibility.

What you’ll do (Essential Responsibilities)
• Review and process all requests for oncology services
• Work with Medical Director/Physician reviewer for all requests requiring physician review
• Communicate with member, provider, facility and all internal work groups regarding outcome of requests
• Maintain a working knowledge of all clinical processes and workflows, as well as all employer benefit plans and how to access needed information
• May serve as a Subject Matter Expert (SME) for a clinical process or content area; may participate in educational training with clinical staff regarding oncology nursing services
• Identification of members who may be appropriate for case management services (Complex, High cost, Transplant); Identify care coordination opportunities and work with clinical teams to coordinate oncology services
• All other duties as assigned.

What you’ll bring (Qualifications)
• Licensure and Credentialing: Must hold an active, unrestricted, and unencumbered professional license in good standing with the state board of licensure in one of the applicable clinical disciplines: Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Pharmacist (PharmD), or other licensed healthcare professional authorized to conduct an assessment independently. Where applicable, clinicians must hold a Multi-State License (MSL) issued through the relevant licensure compact (e.g., Nurse Licensure Compact for RNs). For clinicians in states that do not offer MSL, or for disciplines for which an MSL program has not been launched, employees must be willing and able to obtain and maintain additional state licenses as required to support members served by the organization. Both the MSL and individual state licenses must be obtained within 90 days of hire. Maintenance of required licensure, including timely renewal and compliance with state board regulations, is a condition of employment.
• Oncology certification preferred
• Education: Bachelor’s degree in nursing or closely related field or equivalent experience
• Experience: Minimum of 2 years of oncology nursing experience
• Strong working knowledge of NCCN (National Cancer Comprehensive Network) guidelines
• Excellent critical thinking skills
• Strong interpersonal skills
• Excellent verbal and written communication skills
• Self-directed, organized with excellent time management skills
• Excellent computer skills including Microsoft applications
• Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies.