- Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans
- Review and assess the appropriateness of ongoing cancer treatment plans
- Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness
- Liaise with providers, insurance companies, and patients to clarify treatment options and coverage
- Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
- Partner with clinical and operational teams to support value-based care
- Ensure compliance with organizational policies, regulatory standards, and payer requirements
- Participate in the development and improvement of utilization management protocols
Data Analysis