Oncology Prior Authorization Case Manager, Non-RN

This is a fully remote position, open to applicants in Florida.

📋 Description

• Conduct ongoing evaluations for clinical utilization and determine the need for continued authorization.

• Collaborate with the Nurse Case Manager and healthcare team to promote optimal patient outcomes.

• Oversee a designated patient caseload and ensure that criteria for continued authorization are maintained.

• Execute timely reviews for services necessitating authorization for continuation of care.

• Adhere to payer or clinical guideline authorization criteria.

• Assess coverage benefits and limitations to evaluate the appropriateness of requested services.

• Foster interdepartmental communication regarding continued authorization status prior to patient appointments.

• Relay authorization status and decisions to clinical teams and, when necessary, to patients.

• Detect potential treatment delays by examining treatment plans.

• Proactively inform healthcare teams and patients of possible treatment barriers.

• Maintain a thorough understanding of payer reimbursement policies and clinical guidelines.

• Comply with University and departmental policies and procedures while safeguarding University assets.

⛳️ Requirements

• A Bachelor’s degree in a relevant field is required.

• At least 2 years of relevant experience is required.

• Familiarity with payer reimbursement policies and clinical guidelines.

• Capability to perform timely utilization reviews for authorization continuation.

• Proficient in reviewing coverage benefits and limitations.

• Ability to coordinate with nurse case managers and healthcare teams.

• Skill in communicating authorization status and decisions to clinical teams and patients.

• Ability to identify potential treatment delays and authorization obstacles.

• Commitment to adhere to University and departmental policies and procedures.

🏝️ Benefits

• Competitive salaries.

• Comprehensive benefits package.

• Medical insurance.

• Dental insurance.

• Tuition remission.