Oncology Prior Authorization Case Manager, Non-RN - Remote

About the role

The University of Miami Health System is seeking a full‑time Oncology Prior Authorization Case Manager to work remotely. In this role you will conduct initial, concurrent and retrospective chart reviews to ensure appropriate clinical utilization and timely authorizations, acting as a liaison among patients, providers, and insurers.

Key responsibilities

• Perform prospective and concurrent reviews for services requiring prior authorization.
• Apply payer‑specific criteria and clinical guidelines to assess coverage benefits.
• Communicate denials, peer‑to‑peer requests, and authorization status to the healthcare team and, when appropriate, to patients.
• Identify potential treatment delays or inappropriate utilization and recommend alternative options.
• Maintain up‑to‑date knowledge of payer reimbursement policies and clinical guidelines.
• Proactively inform leadership of barriers or delays in care and prioritize caseload accordingly.

Required profile

• Bachelor’s degree in a relevant field or equivalent experience.
• Minimum of 2 years of relevant experience, preferably in oncology utilization review.
• Strong understanding of authorization processes and payer policies.

Required skills