Remote Oncology Prior-Auth Case Manager - Non-RN

University of Miami; Miami (FL); Remote; USD 55,000 - 75,000; Full time

Job summary

University of Miami is seeking an Oncology Prior Authorization Case Manager, Non-RN, to work remotely with a focus on efficient utilization review and patient care coordination. The role involves chart reviews, payer policy application, and seamless communication with clinical teams and patients.

Qualifications include a Bachelor’s degree or equivalent and a minimum of 2 years in related work, with oncology experience preferred.

Qualifications

• Bachelor’s degree in relevant field (or equivalent).
• Minimum of 2 years of relevant experience; Oncology preferred.
• Experience with prior authorization and utilization review processes is a plus.

Responsibilities

• Conduct prospective, concurrent and retrospective chart reviews for prior authorization.
• Apply payer criteria and clinical guidelines to determine appropriateness of services.
• Facilitate communication of denials and Peer to Peer requests between payers and the clinical team.
• Identify barriers to care and coordinate alternative treatment options as needed.
• Maintain timely updates on authorization status to the clinical team and patient.

Skills

Prior authorization

Utilization review

Healthcare coordination

Education

Bachelor’s degree

Equivalent experience

Job description

University of Miami is seeking an Oncology Prior Authorization Case Manager, Non-RN, to work remotely with a focus on efficient utilization review and patient care coordination. The role involves chart reviews, payer policy application, and seamless communication with clinical teams and patients.

Qualifications include a Bachelor’s degree or equivalent and a minimum of 2 years in related work, with oncology experience preferred.