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Oncology Prior Authorization Case Manager, Non-RN
University of Miami. Complete ongoing reviews for clinical utilization and identify the need for continued authorization .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical utilization reviews and authorization processes, ensuring compliance with payer reimbursement policies and clinical guidelines while effectively coordinating with healthcare teams to optimize patient outcomes.
Highest-signal resume keywords
Utilization ReviewPayer Reimbursement PoliciesClinical GuidelinesPatient CoordinationAuthorization Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Utilization ReviewAuthorization Criteria ReviewCoverage Benefits AnalysisTreatment Plan ReviewTimely Authorization Processing
Soft Skills
Effective CommunicationInterdepartmental CoordinationProblem IdentificationProactive Communication
Certifications & Qualifications
Bachelor’s Degree
Industry Keywords
HealthcarePatient OutcomesAuthorization StatusTreatment DelaysUniversity Policies
About the role
Key responsibilities & impact- Complete ongoing reviews for clinical utilization and identify the need for continued authorization
- Coordinate with the Nurse Case Manager and healthcare team to support optimal patient outcomes
- Manage a designated patient caseload and ensure criteria for continued authorization remain in place
- Perform timely reviews for services requiring authorization for continuation of care
- Follow payer or clinical guideline authorization criteria
- Review coverage benefits and limitations to determine appropriateness of requested services
- Facilitate interdepartmental communication about continued authorization status before patient appointments
- Communicate authorization status and determinations to clinical teams and occasionally patients
- Identify potential treatment delays by reviewing treatment plans
- Proactively communicate potential treatment barriers to healthcare teams and patients
- Maintain knowledge of payer reimbursement policies and clinical guidelines
- Adhere to University and department policies and procedures and safeguard University assets
Requirements
What you’ll need- Bachelor’s degree in relevant field required
- Minimum 2 years of relevant experience required
- Knowledge of payer reimbursement policies and clinical guidelines
- Ability to complete timely utilization reviews for authorization continuation
- Ability to review coverage benefits and limitations
- Ability to coordinate with nurse case managers and healthcare teams
- Ability to communicate authorization status and determinations to clinical teams and patients
- Ability to identify potential treatment delays and authorization barriers
- Ability to adhere to University and department policies and procedures
Benefits
Comp & perks- Competitive salaries
- Comprehensive benefits package
- Medical insurance
- Dental insurance
- Tuition remission