Oncology Prior Authorization Case Manager
Join to apply for the Oncology Prior Authorization Case Manager, Non-RN - Remote role at University of Miami
3 days ago – be among the first 25 applicants.
Full‑time, staff position. Pay Grade H8. Remote.
Job Summary
Utilization Review Case Manager responsible for initial, concurrent and retrospective chart reviews for clinical utilization and authorization for oncology patients. Coordinates with healthcare team to provide optimal patient outcomes, avoid treatment delays and authorization denials, and serves as liaison between patient/family, healthcare personnel and insurers.
Core Functions
• Conduct timely prospective and concurrent reviews for services requiring prior authorization.
• Follow authorization process using established payer or clinical guidelines.
• Accurately review coverage benefits and payer policy limitations to determine appropriateness of requested services.
• Refer to the treatment plan for clinical reviews per established criteria and guidelines.
• Facilitate communication of denials and peer‑to‑peer requests between payers and the healthcare team.
• Identify potential delays in treatment or inappropriate utilization and provide education regarding payer policies and coordinate alternative treatment options.
• Maintain effective communication of authorization status and determination to clinical team and/or patient.
• Proactively communicate with leadership regarding barriers or potential delays and identify opportunities for expedited requests and prioritize caseload accordingly.
• Maintain knowledge regarding payer reimbursement policies and clinical guidelines.
• Additional duties may be assigned as necessary.
Core Qualifications
Education
• Bachelor’s degree in a relevant field or equivalent.
Experience
• Oncology – Preferred.
• Minimum 2 years of relevant experience.
• Any relevant education, certifications and/or work experience may be considered.
Benefits: Competitive salary and comprehensive benefits package including medical, dental, tuition remission and more. University of Miami is an Equal Opportunity Employer.
Location: Remote; willing to travel to South Florida if needed.
Apply tot his job
Apply To this Job
3 days ago – be among the first 25 applicants.
Full‑time, staff position. Pay Grade H8. Remote.
Job Summary
Utilization Review Case Manager responsible for initial, concurrent and retrospective chart reviews for clinical utilization and authorization for oncology patients. Coordinates with healthcare team to provide optimal patient outcomes, avoid treatment delays and authorization denials, and serves as liaison between patient/family, healthcare personnel and insurers.
Core Functions
• Conduct timely prospective and concurrent reviews for services requiring prior authorization.
• Follow authorization process using established payer or clinical guidelines.
• Accurately review coverage benefits and payer policy limitations to determine appropriateness of requested services.
• Refer to the treatment plan for clinical reviews per established criteria and guidelines.
• Facilitate communication of denials and peer‑to‑peer requests between payers and the healthcare team.
• Identify potential delays in treatment or inappropriate utilization and provide education regarding payer policies and coordinate alternative treatment options.
• Maintain effective communication of authorization status and determination to clinical team and/or patient.
• Proactively communicate with leadership regarding barriers or potential delays and identify opportunities for expedited requests and prioritize caseload accordingly.
• Maintain knowledge regarding payer reimbursement policies and clinical guidelines.
• Additional duties may be assigned as necessary.
Core Qualifications
Education
• Bachelor’s degree in a relevant field or equivalent.
Experience
• Oncology – Preferred.
• Minimum 2 years of relevant experience.
• Any relevant education, certifications and/or work experience may be considered.
Benefits: Competitive salary and comprehensive benefits package including medical, dental, tuition remission and more. University of Miami is an Equal Opportunity Employer.
Location: Remote; willing to travel to South Florida if needed.
Apply tot his job
Apply To this Job