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Clinical Authorization Specialist
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Job Description
- Req#: JR-1385
Employer Industry: Cancer Research and Patient Care
Why consider this job opportunity:
- Salary up to $95,400.00
- Opportunity for career advancement and growth within the organization
- Work in a supportive and inclusive environment dedicated to patient care and research
- Engage in meaningful work that impacts cancer treatment and public health
- Collaborate with a team of dedicated professionals in a leading cancer institute
What to Expect (Job Responsibilities):
- Manage the approval process for clinically complex cases, including discussions with attending physicians regarding medical necessity
- Complete medical literature searches and coordinate discussions between providers and payers
- Assist with medical necessity denial reviews and coordinate the appeal process
- Root cause claim denials and submit claim appeals while creating drug cost estimates for waivers
- Serve as a clinical resource for the Revenue Integrity and Billing Compliance team
What is Required (Qualifications):
- Bachelor’s degree required; BSN preferred
- Minimum of 1 year of clinical and/or related experience required, with preference for Case Management, Utilization Review, or Prior Authorization experience
- Knowledge of third-party payer rules and regulations is highly desirable
- Ability to work with sensitive patient information and maintain confidentiality
- Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred
How to Stand Out (Preferred Qualifications):
- Experience in Case Management, Utilization Review, or Prior Authorization
- Strong analytical and problem-solving skills
- Proficiency in various computing/information systems and Microsoft Office
- Ability to mentor and educate team members
- Experience in a fast-paced, high-demand healthcare environment
#CancerResearch #PatientCare #ClinicalAuthorization #HealthcareCareers #InclusiveWorkplace
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