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Oncology Prior Authorization Case Manager, Non-RN
University of Miami. Conduct initial, concurrent, and retrospective chart reviews for clinical utilization and authorization .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting clinical chart reviews and managing patient caseloads while ensuring compliance with payer policies and clinical guidelines. Strong communication skills facilitate effective coordination among healthcare teams, patients, and insurers to optimize patient outcomes.
Highest-signal resume keywords
Clinical Chart ReviewPatient Caseload ManagementAuthorization ProcessesOncology ExperiencePayer Policy Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Chart ReviewUtilization ManagementAuthorization CoordinationPatient Needs EvaluationProspective ReviewConcurrent ReviewDenial CommunicationTreatment CoordinationCompliance FacilitationPayer Criteria Application
Soft Skills
CommunicationCollaborationProblem-SolvingLiaison SkillsOrganizational Skills
Industry Keywords
HealthcareOncologyPatient OutcomesReimbursement PoliciesClinical Guidelines
About the role
Key responsibilities & impact- Conduct initial, concurrent, and retrospective chart reviews for clinical utilization and authorization
- Coordinate with the healthcare team for optimal and efficient patient outcomes while avoiding treatment delays and authorization denials
- Manage a designated patient caseload
- Communicate progress and determinations to the clinical team and/or patient
- Monitor care and act as a liaison between patients/families, healthcare personnel, and insurers
- Evaluate patient needs and available resources
- Recommend and facilitate outcomes that meet ongoing patient needs and encourage compliance with medical advice
- Perform prospective reviews for services requiring prior authorization and concurrent reviews for continuation-of-care services
- Follow authorization processes using payer criteria or clinical guidelines
- Review coverage benefits and payer policy limitations
- Facilitate communication of denials and Peer-to-Peer requests
- Identify treatment delays or inappropriate utilization and assist with alternative treatment coordination
- Communicate authorization status and determinations
- Communicate barriers or potential delays to leadership
- Identify expedited requests and prioritize caseload
- Maintain knowledge of payer reimbursement policies and clinical guidelines
Requirements
What you’ll need- Bachelor’s degree in relevant field; or equivalent
- Minimum of 2 years of relevant experience
- Oncology preferred
- Any relevant education, certifications and/or work experience may be considered
Benefits
Comp & perks- Competitive salaries
- Medical insurance
- Dental insurance
- Tuition remission