Conducts clinical case reviews referred by case management staff and/or other health care professionals to meet regulatory requirements and assure effective and efficient utilization of health care services. Communicates with case and utilization management to discuss selected cases and make recommendations regarding level of care. This is a remote position and you must be licensed in the state of Texas.

In this role, you will provide medical expertise and leadership in assessing the clinical necessity and appropriateness of oncology treatments, while ensuring cost-effective care without compromising patient outcomes. Conduct medical reviews of hematology and oncology treatment plans to determine medical necessity.