Clinical Utilization Management Coordinator

American Oncology Partners, PA; Warner Robins (GA); On-site; USD 42,000 - 61,000; Full time

Benefits offered by this job

Ergonomic seating

Flexible schedules

Accessible workstations

Screen reader software

Job summary

American Oncology Network in Central Georgia is seeking a Clinical Utilization Management Coordinator to ensure quality patient care while managing pre-authorizations with payers. You will review medical necessity, coordinate with providers, and keep the clinical team informed on authorization status to avoid treatment delays.

Ideal candidates have an accredited nursing degree with RN or LPN licensure and 2+ years in utilization management, preferably in oncology, plus strong communication and

Qualifications

• Graduate of an accredited nursing program with current RN or LPN licensure.
• Two years LPN or RN experience; oncology preferred.
• Two years experience in utilization management and obtaining insurance authorizations in a medical setting.
• Must have excellent interpersonal and communication skills, be very detail-oriented and a self-starter.

Responsibilities

• Conduct concurrent review to maintain active pre-authorization for scheduled treatments and procedures.
• Review precertification and authorization requests for medical necessity and verify required approvals prior to treatment.
• Monitor treatment plans and other clinical activities that may impact authorizations or require payer approval.
• Communicate with payer plans regarding authorization requirements, coverage determinations, and approvals.
• Provide timely updates to physicians and clinical teams regarding authorization status and payer determinations.
• Escalate authorization barriers or payer-related concerns that may delay or impact treatment.
• Advocate for timely, high-quality patient care while ensuring alignment with payer requirements.

Skills

Communication

Organization

Collaboration

Documentation

Analysis

Advocacy

Travel

Education

RN or LPN licensure

Job description

Location: Central Georgia Cancer Care Hiring Range: $30.34 - $43.97

Position Summary

The Clinical Utilization Management Coordinator role is to ensure that health care services are administered with quality, drug cost efficiency, and compliant with payer policy. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive treatment/procedures without pre-authorization from payer obtained. Communicating to provider payer position specific to medical necessity

Key Performance Areas

KPA 1 - Utilization Management & Authorization Review

• Conduct concurrent review of patient clinical information to ensure active pre-authorization is maintained for scheduled treatments and procedures.
• Review precertification and authorization requests for medical necessity and verify that required approvals are in place prior to treatment delivery.
• Monitor new treatment plans, treatment changes, and other clinical activities that may impact existing authorizations or require additional payer approval.
• Apply clinical knowledge, critical thinking, and independent judgment when reviewing authorization requirements and resolving payer-related issues.

KPA 2 - Payer Coordination & Requirements

• Communicate with payer plans regarding authorization requirements, coverage determinations, and treatment-related approvals.
• Identify and communicate payer-imposed requirements that may impact treatment delivery, including formulary restrictions, pharmacy substitutions, and other coverage limitations.
• Partner with providers to address payer exceptions and facilitate necessary treatment modifications when required by the patient’s health plan.

KPA 3 - Provider & Clinical Team Communication

• Provide timely updates to physicians, clinical teams, and other healthcare providers regarding authorization status, outstanding requirements, and payer determinations.
• Coordinate with clinical and non-clinical staff supporting treatments that require pre-authorization.
• Escalate authorization barriers or payer-related concerns that may delay or impact treatment.

KPA 4 - Patient Care Support

• Advocate for timely, high-quality patient care while ensuring treatment plans remain aligned with payer requirements and authorization guidelines.
• Support continuity of care by proactively identifying authorization issues that could affect treatment scheduling or delivery.

KPA 5 - Documentation & Compliance

• Maintain accurate, complete, and timely documentation of all pre-authorization, precertification, payer communication, and related utilization management activities.
• Ensure authorization-related records are maintained in accordance with organizational procedures and applicable payer requirements.
• Manage multiple priorities in a fast-paced environment with minimal supervision.
• Maintain a high level of organization, accuracy, and follow-through when managing authorization activities.
• Demonstrate effective interpersonal and communication skills when working with providers, clinical staff, payers, and other stakeholders.

Position Qualifications/Requirements

Education

Graduate of an accredited nursing program with current LPN or RN licensure.

Minimum Relevant Experience

• Two years LPN or RN experience; physicians practice; oncology preferred.
• Two years experience in utilization management and obtaining insurance authorizations in a medical setting.
• Relevant clerical or case management work in a medical office setting.
• Must have excellent interpersonal and communication skills, be very detail-oriented and a self-starter.

Certifications/Licenses

State Licensure as a Licensed Practice Nurse (LPN) or Registered Nurse (RN) Utilization Management or Case Management certification preferred.

Skills

• Communication
• Organization
• Collaboration
• Documentation
• Analysis
• Advocacy
• Travel: 0-25%

Expectations for All Employees

This position description reflects the general duties and responsibilities necessary to perform the principal functions of the job, as identified, and shall not be considered an exhaustive list of job responsibilities which may be inherent in the job. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. The responsibilities listed may be subject to change at any time and individuals may be asked to perform duties outside of your regular responsibilities to support the ongoing business operation needs.

Americans with Disabilities Act (ADA) Compliance

The essential functions described herein are intended to define the fundamental duties of the position and serve as the minimum requirements for performance. They do not represent an exhaustive list of all job duties that may be required. AON complies with the Americans with Disabilities Act (ADA) and applicable state and local laws. The Company will engage in an interactive process to evaluate and, where appropriate, provide reasonable accommodations to qualified individuals with disabilities, provided such accommodations do not impose an undue hardship on the business.

Physical Requirements

• Sitting for extended periods
• Occasional walking and standing
• Ability to use computer and phone

Cognitive Requirements

• Interpersonal communication
• Data entry accuracy
• Understanding of billing and insurance procedures

Environmental Requirements

• Office environment within patient care areas
• Potential exposure to airborne illnesses

Accommodation Notes

• Ergonomic seating
• Flexible schedules
• Accessible workstations
• Screen reader software

#AONN #LI-ONSITE

American Oncology Network

AON is an alliance of physicians and veteran healthcare leaders dedicated to ensuring the long-term success and viability of oncology diagnosis and treatment in community-based settings. It is the fastest growing national network of community oncology practices delivering local access to exceptional cancer care. AON serves its expanding network of partner practices by providing proven practice management expertise. Our employees across the country work together to empower physicians to make cancer care better. By driving integrated, collaborative care, we are proudly helping community oncologists deliver the highest quality care to every patient. Cancer touches everyone. Being able to make a difference in the lives of those fighting this disease is something our employees at AON cherish and never take for granted. A career in oncology offers all sorts of rewards. But working at AON offers employees more than most. As a fast-growing national company, the opportunity to join a national workforce with flexible work options is available. We offer competitive compensation packages that include comprehensive health insurance with a robust provider network. Our 401k, which offers a 100% match and investment options, is available to full-time and part‑time staff members, and we feature a generous Paid Time Off (PTO) program. At AON, we offer you more than a job, we offer you a career. As a network of independent oncology practices working together as one, we host annual summits each year, providing our employees a chance to collaborate with AON peers from across the country. Promoting from within is a priority at AON, and we support our team members continued growth through professional development programs and tuition assistance.