Oncology Utilization Management Nurse

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

About This Opportunity:
As a Utilization Management Nurse, you will make a real impact each day by delivering comprehensive, patient centered care across a full range of cases, with a strong focus on oncology. You’ll assess individual needs, shape personalized care plans, and partner with the right providers and care teams to keep patients moving in the right direction. Your clinical insight will help members navigate the healthcare system with confidence, stay engaged in their treatment plans, and achieve strong outcomes through clear communication, education, and steady support. You’ll also play a key role in promoting wellness, using resources responsibly, and ensuring we meet all regulatory and organizational standards.


Things You’ll Do Here:

• Review prospective, concurrent, and retrospective UM cases, with a focus on oncology, and apply the appropriate criteria and plan documents.
• Work with providers and internal partners to make sure the right guidelines are used within the required timelines.
• Support quality care and cost-effective outcomes that help members stay healthy and engaged.
• Follow CMS, URAC, and other regulatory requirements tied to UM activities.
• Flag any potential overuse, underuse, or misuse of services.
• Identify high risk, catastrophic, or disease management cases and route them to the right teams.
• Communicate UM decisions clearly with providers and members so everyone stays aligned.
• Document UM activities accurately and maintain confidentiality at all times.
• Participate in ongoing education to keep your UM knowledge fresh and current.
• Help support smooth transitions of care for inpatient members, including early discharge planning.
• Bring forward any potential quality or patient safety concerns.
• Take on additional responsibilities as needed to support the team.

• 3+ years of clinical nursing experience, preferably with exposure to oncology care
• 1+ years of UM experience
• Active, Unrestricted RN License in your state of residence.
• Ability to work in a fast-paced, detailed, deadline-driven environment.
• Ability to maintain strict confidentiality and handle sensitive information with discretion.
• Experience working independently with strong problem solving and organization skills.
• Strong aptitude for relationship building with a highly effective communication style.

• Utilization Management or Case Management Certification.

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
• Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
• Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.