Director, Authorizations Outpatient Oncology

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 700 teammates in 75+ clinic locations and growing. TOI is changing oncology for the better.

Position Summary

The Director of Central Operations – Prior Authorization is responsible for leading and optimizing the prior authorization function across The Oncology Institute’s (TOI) national footprint. This role ensures timely and accurate processing of prior authorizations, supports payer compliance, and drives operational excellence through data-driven decision-making and cross-functional collaboration.

Key Responsibilities

• Lead the Prior Authorization team, overseeing daily operations, staffing, and performance management.
• Develop and implement standardized workflows and KPIs to improve turnaround time, reduce denials, and enhance payer compliance.
• Collaborate with Revenue Cycle Management (RCM), Utilization Management (UM), Clinical Operations, and Technology teams to streamline processes and improve automation.
• Monitor and report on key metrics including authorization approval rates, denial trends, and productivity benchmarks.
• Partner with Credentialing, Intake, and Call Center teams to ensure seamless patient access and coordination.
• Identify and implement opportunities for automation and system enhancements in collaboration with IT and Med Econ.
• Serve as a subject matter expert on payer requirements and regulatory changes impacting prior authorization.
• Support strategic initiatives related to central ops optimization, including new market integration and M&A transitions.

Qualifications

• Bachelor’s degree in healthcare administration, business, or related field required; Master’s preferred.
• Minimum 5–7 years of experience in healthcare operations, with at least 3 years in a leadership role overseeing prior authorization or related RCM functions.
• Proven track record of improving operational performance through metrics, process redesign, and team development.
• Strong understanding of payer policies, oncology workflows, and regulatory compliance.
• Experience with EHR systems (e.g., Centricity), payer portals, and automation tools preferred.
• Excellent communication, leadership, and cross-functional collaboration skills.

Success Metrics

• Reduction in prior auth turnaround time and denial rates.
• Improved staff productivity and engagement.
• Increased automation and system utilization.
• Positive feedback from clinical and operational stakeholders.