Job Description

Overview

The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services. This includes but is not limited to autologous and allogeneic stem cell transplants, Gene Therapy, chimeric antigen receptor (CAR) T-cell therapy, and other immune effector cell treatments. The Specialist works autonomously to secure initial and ongoing authorizations, monitor payer-specific requirements, and resolve denials and claim issues to ensure timely access to care for patients.

Functioning in a high-acuity, fast-paced environment, this role requires strong clinical acumen, advanced problem-solving abilities, and extensive payer knowledge. The Specialist acts as a critical liaison between Dana-Farber Cancer Institute, health plans, and clinical teams to advocate for patient access to life-saving therapies.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

Responsibilities

• Oversee the full lifecycle of payer authorizations for Blood and Marrow Transplant (BMT) and Immune Effector Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review, appeals, and preparation of cost estimates for insurance waivers and non-covered services.
• Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to gather and interpret treatment intent, clinical justification, and anticipated timelines.
• Prepare and submit comprehensive clinical documentation to payers to facilitate timely and accurate authorization determinations.
• Monitor, interpret, and implement payer policy changes to ensure adherence to evolving coverage guidelines for transplant and cellular therapy services.
• Identify potential barriers to authorization proactively, coordinate alternative strategies, and advise clinical teams on best practices for payer engagement.
• Investigate authorization-related claim denials, perform root cause analyses, and oversee the timely submission of appeals or corrected claims.
• Develop and deliver educational resources to internal staff regarding payer trends, policy modifications, and process enhancements related to BMT and IEC authorizations.

Qualifications

• Bachelor’s degree required. BSN preferred.
• 1 year clinical and/or related experience required.
• Case Management, Utilization Review, Oncology, Cellular Therapy and/or Prior Authorization experience is preferred. 
• Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Ability to mentor and educate team members, including by example.
• Ability to function independently and prioritize work within established policies.
• Ability to prioritize, meet pre-determined deadlines and work in high pressure situations.
• Good judgment, tact, sensitivity and the ability to function in a fast paced, highly demanding environment.
• Ability to work with sensitive patient information and maintain confidentiality.
• Demonstrated knowledge of third-party payer rules and regulations highly desirable.
• Ability to work closely and effectively with colleagues across the organization including medical staff.
• Shows strong analytical and problem-solving skills.
• Strong understanding and ability to work in various computing/information systems and Microsoft Office product suite.

At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong.  As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff.  Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.

Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.

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