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 (Non‑RN) to work remotely. You will conduct prospective, concurrent, and retrospective chart reviews to ensure appropriate utilization and timely authorizations for oncology patients.

Key responsibilities

• Perform timely prospective reviews for services requiring prior authorization and concurrent reviews for ongoing care.
• Apply payer criteria and clinical guidelines to assess coverage benefits and policy limitations.
• Communicate denials, peer‑to‑peer requests, and authorization status to the clinical team and, when appropriate, to patients.
• Identify potential treatment delays or inappropriate utilization and recommend alternative options.
• Maintain a designated patient caseload, providing interventions to reduce avoidable delays.
• Serve as a liaison among patients, families, healthcare providers, and insurers.
• Proactively inform leadership of barriers or potential delays in care.

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 knowledge of payer reimbursement policies and clinical guidelines.

Required skills