Oncology Prior Authorization Lead

OneOncology; Huntsville (AL); On-site; USD 90,000 - 120,000; Full time

Job summary

Clearview Cancer Institute in North Alabama seeks an experienced Prior Authorization Director to lead a dedicated team handling hematology and oncology PA submissions. You will ensure timely access to therapies by coordinating with clinicians, insurance companies, and patients, guided by clinical guidelines and payer requirements.

The role requires a bachelor’s in nursing, pharmacy, or healthcare administration, with oncology PA experience and strong analytical skills.

Qualifications

• Bachelor's degree in nursing, pharmacy, or healthcare administration is required.
• Master's degree is preferred but not required.
• Extensive knowledge of oncology treatments, clinical guidelines and payer policies.
• Proven experience in prior authorization management, particularly in oncology.
• Strong analytical and problem‑solving skills; excellent communication and interpersonal skills.
• Ability to collaborate with diverse stakeholders.

Responsibilities

• Oversee a team of oncology prior authorization specialists, assigning tasks and coaching for accuracy and efficiency.
• Review oncology/hematology treatment plans and patient records to determine necessary prior authorizations.
• Stay updated on payer policies and communicate changes to the team.
• Collaborate with providers, nurses, and patients to address delays, denials, and appeals as needed.
• Analyze data to identify trends, generate leadership reports, and improve turnaround times and denial reasons.
• Ensure compliance with regulatory guidelines and implement quality control for submissions.

Skills

Analytical thinking

Communication skills

Team leadership

Problem solving

Education

Bachelor's degree in nursing, pharmacy, or healthcare administration

Master's degree preferred

Job description

Clearview Cancer Institute in North Alabama seeks an experienced Prior Authorization Director to lead a dedicated team handling hematology and oncology PA submissions. You will ensure timely access to therapies by coordinating with clinicians, insurance companies, and patients, guided by clinical guidelines and payer requirements.

The role requires a bachelor’s in nursing, pharmacy, or healthcare administration, with oncology PA experience and strong analytical skills.