Oncology Prior Authorization Case Manager, Non-RN

Job not on LinkedIn

🔥 1 minute ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 18%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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University of Miami

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1925

🏥 Healthcare

📚 Education

💰 $1M Grant on 2023-02

Healthcare • Education

University of Miami is a prestigious private research university located in Coral Gables, Florida. It offers a wide range of undergraduate, graduate, and professional degree programs through its numerous schools and colleges, including the School of Architecture, College of Arts and Sciences, and Miami Herbert Business School among others. The university is recognized for its contributions to research, particularly in areas such as marine and atmospheric science through the Rosenstiel School, as well as in medicine through the Miller School of Medicine. The institution is also noted for its vibrant student life, with a strong emphasis on athletics and community engagement. University of Miami is committed to fostering an inclusive educational environment and is home to a diverse student body from around the globe.

📋 Description

• 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

• 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

• Competitive salaries • Medical insurance • Dental insurance • Tuition remission