Melissa Saxon Aocnp
Oncology Nurse Practitioner Clinical Reviewer @Evolent
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WORK HISTORY
Oncology Nurse Practitioner Clinical Reviewer @Evolent
Serve as the specialty match reviewer in Oncology cases that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.• Provides clinical rationale for standard and expedited appeals.• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.• Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.• Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.• Participates in on-going training per inter-rater reliability process.
EDUCATION
Clemson University
Master of Science - MS, Family Practice Nurse/Nursing
Tri-County Technical College
Associate's degree, Nursing
Lander University
Bachelor's degree, Nursing
ABOUT MELISSA SAXON AOCNP
Oncology Nurse Practitioner/Clinical Reviewer
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