Remote Oncology Utilization Case Manager

University of Miami; Oregon; Hybrid; USD 56,000 - 75,000; Full time

Benefits offered by this job

Medical benefits

Tuition remission

Competitive salary

Job summary

University of Miami is seeking a Remote Utilization Case Manager to perform ongoing reviews for clinical utilization and determine the need for continued authorization. You will coordinate with the Nurse Case Manager and Healthcare team to support timely patient care while avoiding delays and denials.

The role requires a Bachelor's degree and at least 2 years of relevant experience, with responsibilities including interdepartmental communication and adherence to payer criteria and clinical

Qualifications

• Bachelor's degree in a relevant field.
• Minimum 2 years of relevant experience.

Responsibilities

• Adhere and perform timely reviews for services requiring an authorization for continuation of care.
• Follows the authorization process using established criteria as set forth by the payer or clinical guidelines.
• Accurate review of coverage benefits and limitations to determine continued appropriateness of services requested.
• Facilitates interdepartmental communication regarding status of continued authorization in advance of patient's appointment.
• Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.
• Identifies potential delays in treatment by reviewing the treatment plan and proactively communicates with the healthcare team and or patient regarding the potential treatment barrier.
• Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
• Adheres to University and department level policies and procedures and safeguards University assets.

Education

Bachelor's degree in relevant field

Job description

University of Miami is seeking a Remote Utilization Case Manager to perform ongoing reviews for clinical utilization and determine the need for continued authorization. You will coordinate with the Nurse Case Manager and Healthcare team to support timely patient care while avoiding delays and denials.

The role requires a Bachelor's degree and at least 2 years of relevant experience, with responsibilities including interdepartmental communication and adherence to payer criteria and clinical