Oncology Prior Authorization Lead

Astera Cancer Care; Hillmont (AL); On-site; USD 85,000 - 110,000; Full time

Job summary

Clearview Cancer Institute is seeking a dedicated leader to oversee the oncology prior authorization department in a fast-paced outpatient setting. You will manage a team of prior authorization specialists, review treatment plans for clinical necessity, and navigate payer requirements to secure timely approvals for hematology/oncology therapies.

The role requires strong analytics, cross-functional collaboration with clinicians, and a focus on compliance and process improvement to reduce delays

Qualifications

• Bachelor’s degree in nursing, pharmacy, or healthcare administration.
• Experience in prior authorization management, preferably in oncology.
• Strong analytical and problem-solving skills to navigate payer requirements.
• Excellent communication and interpersonal skills to collaborate with stakeholders.

Responsibilities

• Lead a team of oncology prior authorization specialists, assign tasks and coach performance.
• Develop and implement strategies to optimize productivity and meet targets.
• Conduct clinical reviews of oncology treatment plans to determine authorization requests.
• Stay updated on payer policies and communicate changes to the team.
• Collaborate with providers, nurses, and patients to address delays or denials.
• Analyze data to identify trends and opportunities for cost savings.
• Generate reports on approvals, turnaround times, and denial reasons.
• Ensure compliance with regulatory guidelines and implement QA measures.

Skills

Team leadership

Healthcare industry knowledge

Regulatory compliance

Data analysis

Communication skills

Project management

Education

Bachelor’s degree in nursing

Bachelor’s degree in pharmacy

Bachelor’s degree in healthcare administration

Master’s degree preferred

Tools

EHR systems

Payer portals

Job description

Clearview Cancer Institute is seeking a dedicated leader to oversee the oncology prior authorization department in a fast-paced outpatient setting. You will manage a team of prior authorization specialists, review treatment plans for clinical necessity, and navigate payer requirements to secure timely approvals for hematology/oncology therapies.

The role requires strong analytics, cross-functional collaboration with clinicians, and a focus on compliance and process improvement to reduce delays