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 chart reviews, coordinate with clinical teams, and ensure timely authorizations while preventing treatment delays.

Key responsibilities

• Conduct initial, concurrent and retrospective chart reviews for clinical utilization and authorization.
• Coordinate with healthcare teams to ensure optimal patient outcomes and avoid treatment delays.
• Monitor patient caseload, intervene to reduce avoidable delays, and communicate progress or determinations to clinicians and patients.
• Act as liaison among patients/families, providers, and insurers, evaluating needs and recommending resources.
• Review coverage benefits and payer policies to determine appropriateness of services.
• Facilitate denial communications and peer‑to‑peer requests between payers and the care team.
• Identify potential delays or inappropriate utilization and educate staff on payer policies.
• Maintain proactive communication with leadership regarding barriers and prioritize expedited requests.

Required profile

• Bachelor’s degree in a relevant field or equivalent education.
• Minimum of 2 years of relevant experience, preferably in oncology utilization review.

What we offer

• Competitive salary.
• Comprehensive benefits package including medical, dental, and tuition remission.