Prior Authorization Manager

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 north Alabama's leading cancer treatment facility. For over 30 years Clearview Cancer Institute has provided leading-edge treatment and compassionate care to those diagnosed with cancer or blood disorders. Clearview offers every service and amenity needed in an outpatient setting and our dedication to research and involvement in Phase I-IV clinical trials gives our patients the opportunity to receive potentially life-saving treatment options.Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.Job Description:Job purpose: Oversee the process of obtaining prior authorization for hematology and oncology treatments from insurance companies, ensuring timely access to necessary medications and therapies while adhering to clinical guidelines and payer requirements, by managing a team of prior authorization specialist and coordinating with healthcare providers and insurance companies to navigate complex authorization processes.Duties include:Team Leadership:Manage a team of oncology prior authorization specialists, assigning tasks, monitoring performance and providing coaching to ensure efficient and accurate processing of authorization requestsDevelop and implement strategies to optimize team productivity and meet established performance metricsClinical Review and Decision MakingConduct comprehensive reviews of oncology/hematology treatment plans and patient medical records to determine appropriate prior authorization requests based on clinical guidelines, payer policies, and treatment protocolsAnalyze complex medical information to assess the clinical necessity of requested therapies and identify potential issues that may impact authorization approvalsPayer ManagementStay updated on evolving payer policies and reimbursement guidelines, communicating changes to the team and adapting strategies accordinglyPatient AdvocacyCollaborate with healthcare providers, nurses, and patients to address any prior authorization delays or denials, exploring appeals processes when necessaryEnsure clear communication with patients regarding their prior authorization statusData Analysis and ReportingMonitor and analyze prior authorization data to identify trends, areas of improvement, and potential cost savings opportunitiesGenerate reports for leadership regarding prior authorization performance, including approval rates, turnaround times, and denials reasonsCompliance and Quality AssuranceEnsure adherence to all relevant regulatory guidelines and compliance standards related to prior authorization processesImplement quality control measures to monitor accuracy and consistency of prior authorization submissionsEducation/ExperienceRequired bachelor’s degree in nursing, pharmacy, or healthcare administrationMaster’s degree preferred, but not requiredExtensive knowledge of oncology treatments, clinical guidelines and payer policiesProven experience in prior authorization management, particularly within the oncology settingStrong analytical and problem-solving skills to navigate complex patient cases and payer requirementsExcellent communication and interpersonal skills to effectively collaborate with diverse stakeholders.Working conditions:This position works as part the business office of a busy outpatient oncology/hematology clinic overseeing the day-to-day operations of the prior authorization department.Physical requirements:This position requires that the employee be able to sit at a desk and work on a computer for up to eight hours a dayDirect reportsAll Prior Authorization Specialist that are a part of the business office including float prior authorization specialist