Oncology Prior Authorization Case Manager, Non-RN

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

📋 Description

• Perform initial, concurrent, and retrospective reviews of charts for clinical utilization and authorization.

• Collaborate with the healthcare team to ensure optimal patient outcomes, minimizing treatment delays and authorization denials.

• Oversee a specific patient caseload.

• Relay progress and decisions to the clinical team and/or patients.

• Monitor patient care and serve as a liaison among patients/families, healthcare staff, and insurers.

• Assess patient needs and available resources.

• Suggest and facilitate solutions that address ongoing patient needs and promote adherence to medical recommendations.

• Conduct prospective reviews for services that necessitate prior authorization and concurrent reviews for services requiring continued care.

• Adhere to authorization protocols based on payer criteria or clinical guidelines.

• Examine coverage benefits and the limitations of payer policies.

• Manage communication regarding denials and Peer-to-Peer requests.

• Detect treatment delays or inappropriate utilization and assist in coordinating alternative treatment options.

• Provide updates on authorization status and decisions.

• Inform leadership about barriers or potential delays.

• Recognize expedited requests and prioritize the caseload accordingly.

• Stay informed about payer reimbursement policies and clinical guidelines.

⛳️ Requirements

• A bachelor's degree in a relevant field or an equivalent qualification.

• At least 2 years of relevant experience.

• Oncology experience is preferred.

• Any pertinent education, certifications, and/or work experience may also be taken into account.

🏝️ Benefits

• Competitive salaries.

• Medical insurance.

• Dental insurance.

• Tuition remission.