To enhance patient care, the full-time Oncology Prior Authorization Case Manager will conduct chart reviews for clinical utilization and authorization, coordinate with healthcare teams, and manage a designated patient caseload remotely.
Key responsibilities:
Perform timely prospective and concurrent reviews for services requiring prior authorization
Facilitate communication regarding authorization status and manage denials between payers and the healthcare team
Monitor treatment plans to identify potential delays and recommend alternative treatment options
Required qualifications:
Bachelor's degree in a relevant field or equivalent experience
Minimum of 2 years of relevant experience, preferably in oncology
Knowledge of payer reimbursement policies and clinical guidelines
Experience in conducting clinical reviews in accordance with established criteria
Ability to communicate effectively with patients, families, and healthcare personnel
