Remote Oncology Utilization & Authorization Specialist

University of Miami; Miami, Northern (FL, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

The University of Miami Health System is seeking a full-time Utilization Review Case Manager to work remotely. You will perform initial, concurrent and retrospective chart reviews for clinical utilization and authorization, coordinating with the healthcare team to optimize patient outcomes while avoiding delays and denials.

Minimum requirements include a Bachelor’s degree and at least 2 years of relevant experience; oncology experience is preferred.

Qualifications

• Bachelor’s degree in relevant field; or equivalent.
• Minimum of 2 years of relevant experience.

Responsibilities

• Adheres to and performs timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of care services.
• Follows the authorization process using established criteria as set forth by the payer or clinical guidelines.
• Accurate review of coverage benefits and payer policy limitations to determine appropriateness of requested services.
• Refers to the treatment plan for clinical reviews in accordance with established criteria and guidelines.
• Facilitates communication of denials and/or Peer to Peer requests between payers and the healthcare team.
• Identifies potential delays in treatment or inappropriate utilization and coordinates with the team to resolve.
• Ensures effective communication regarding authorization status and determination to the clinical team and the patient when appropriate.

Education

Bachelor’s degree in relevant field; or equivalent

Job description

The University of Miami Health System is seeking a full-time Utilization Review Case Manager to work remotely. You will perform initial, concurrent and retrospective chart reviews for clinical utilization and authorization, coordinating with the healthcare team to optimize patient outcomes while avoiding delays and denials.

Minimum requirements include a Bachelor’s degree and at least 2 years of relevant experience; oncology experience is preferred.