Oncology Clinical Review Nurse

Your Future Evolves Here At Evolent, we are dedicated to transforming the healthcare system by partnering with health plans and providers to improve outcomes for individuals facing complex health conditions. Our goal is to bridge the gaps in fragmented healthcare, ensuring that everyone receives the level of care and compassion we would extend to our loved ones. We value our employees by promoting a healthy work/life balance, offering flexibility, and granting the autonomy needed to excel in your role. Our commitment to diversity and inclusion is at the core of our culture, allowing our team members to bring their authentic selves to work. What You'll Be Doing: As a Clinical Review Nurse, you will play a crucial role in the precertification and prior approval process for oncology treatments, specifically chemotherapy. Operating within your nursing scope under the guidance of the Medical Director, you will apply your independent judgment, utilize medical policies, and follow clinical decision-making criteria to advocate for our members and ensure high-quality care. Conduct pre-certification utilization reviews for oncology treatment requests (chemotherapy). Assess medical necessity and appropriateness of services using clinical review criteria. Document all review rationales and decisions accurately. Identify and escalate cases not meeting clinical criteria to the Medical Director. Report any quality issues to the UM Leadership promptly. Collaborate effectively with physicians and healthcare providers to facilitate quality service provision. Ensure precise data entry and communication of relevant information to team members. Engage in ongoing education initiatives to maintain current knowledge. Be available for occasional shifts on weekends and holidays as needed. Perform additional duties as required. The Experience & Qualifications You'll Need (Required): Current, unrestricted RN or LPN/LVN license in your state of residence. High School Diploma or equivalent. Minimum of three years of direct patient care experience in acute, inpatient, or critical care settings, with a strong preference for oncology experience. Proficient in computer skills, including the MS Office Suite. Excellent interpersonal, oral, and written communication skills. Availability for a 9 AM-6 PM shift, Monday through Friday, with weekend and holiday rotation. Finishing Touches (Preferred): Experience with clinical decision-making criteria sets (e.g., NCCH, Clinical Pharmacology). Utilization Management/Review (UM/UR) experience. Clinical experience specifically in oncology. Certification such as ONS/ONCC Chemotherapy Immunotherapy Certificate or OCN certification. Previous remote work experience. Our hiring process includes identity verification steps to ensure security, requiring a government-issued photo ID and thorough background checks. Candidates may also need to undergo drug screening before employment. The utilization of AI tools during interviews is prohibited to ensure a fair process. Technical Requirements: All employees are required to have the following technical capabilities at home: high-speed internet of over 10 Mbps and, for call center roles, the ability to connect directly to the home internet router. These requirements may change depending on office reopening schedules. Evolent is an equal opportunity employer that values diversity and considers all qualified applicants equally, regardless of various statuses. If you require reasonable accommodations to access any information on this website, please reach out to our recruiting team for assistance. The expected base salary for this position ranges from $32 to $37 per hour. Additionally, this role may include a performance-based bonus component. Evolent offers comprehensive benefits, including health insurance, for qualifying employees. Compensation is based on the skills and experience of the selected candidates and may vary accordingly. If you haven't found your dream job yet, feel free to submit your contact information and resume. We will reach out if a suitable position opens up.

Created: 2026-03-07