Case Review Representative
OncoHealth
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Benefits offered by this job
Job summary
OncoHealth is seeking a Case Review Representative to act as a one-stop intake for calls from members and providers. You will resolve tier 1 issues such as user resets, provider data management, and general questions, while coordinating with multiple teams to ensure timely service.
You will support administrative tasks, triage requests, and manage emails and faxes within a remote/hybrid environment. A college degree or relevant experience is preferred, with strong MS Office and bilingual
Qualifications
- 2+ years of administrative experience and/or customer service is required.
- Fully bilingual in English and Spanish.
- Remote/hybrid work experience preferred.
- Experience with system implementations for program effectiveness is desired.
- Proficient with MS Office Suite.
Responsibilities
- Handle inbound calls and emails, triage requests, and resolve tier 1 issues.
- Manage fax intake, labeling, and prior authorizations.
- Route calls and emails to appropriate teams and track case work.
- Support quality program outreach and performance activities as needed.
Skills
Education
Tools
Job description
OncoHealth delivers the industry's first integrated oncology management solution. Built on deep oncology expertise, our multidisciplinary team designs, delivers, and continuously advances solutions that help health plans and employers manage costs, close care gaps, and improve outcomes while ensuring people with cancer receive timely treatment and meaningful support.
OncoHealth delivers the industry's first integrated oncology management solution. Built on deep oncology expertise, our multidisciplinary team designs, delivers, and continuously advances solutions that help health plans and employers manage costs, close care gaps, and improve outcomes while ensuring people with cancer receive timely treatment and meaningful support.
The Case Review Representative serves as a one-stop shop and intake of all calls (members and providers). Resolves tier one issues (user resets, provider data management, fax and letter receipt, general questions).
- Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 5:00 pm EST (Office hours may change/extend upon operational needs)
- Fax intake and labeling
- Prior authorization creation
- Quality Performance Program Outreach when assigned
- Triage and manage inbound calls, routing case specific calls to an appropriate team member, and resolving tier 1 level issues
- Triage and manage inbound emails from health plan clients, routing case specific emails to an appropriate team member, and resolving tier 1 level issues
- Triage request/claims processing issues to health plans as needed Prior authorization creation
- Quality Performance Program Outreach when assigned
- College degree or relevant experience preferred
- Fully Bilingual (English and Spanish)
- Remote/hybrid work experience preferred
- A minimum of 2 years of administrative experience and/or customer service or relevant educational attainment required
- Skills for implementation of systems for program effectiveness and productivity required
- Systems/Tools: MS Office Suite proficient
OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.
Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!
We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.
The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners & McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!
Oncology Specialized Management
OneUM is our oncology-specific utilization management solution that streamlines prior authorizations, ensuring clinically appropriate, evidence-based care.
Our in-house team, including oncologists and board-certified oncology pharmacists, helps optimize your oncology program with clinical and drug management expertise.
Submit full treatment regimens in a single request, customized to each partner’s needs.
Oncology-trained reviewers evaluate cases holistically. For potential denials, only managed care oncologists conduct peer-to-peers, ensuring timely, appropriate care.
Oncology Supportive Care
Iris provides 24/7 access to oncology trained nurses, therapists, and dietitians to support the physical, emotional, and nutritional challenges of cancer, from diagnosis through survivorship.
Building trusted relationships with members through phone, video, or secure messaging to help prevent avoidable complications while providing continuity of care and personalized support.
Oncology-trained mental health therapists and dietitians offer 1:1 visits, small groups, and interactive events to support whole-person care, well-being, and member satisfaction.
An evidence-based content library supports members between appointments to reinforce confidence, engagement, and quality of life.
On-Demand Data Analytics
Gain a real-time, 360° view of your oncology program with insights from both claims and prior authorization data.
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