Remote Oncology Utilization Review Case Manager

University of Miami; United States; Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Tuition remission

Job summary

University of Miami Health System is seeking a full-time Utilization Review Case Manager to work remotely. The role conducts initial and concurrent chart reviews for utilization and authorization, coordinating with the healthcare team to ensure timely patient care and minimize delays.

The position requires a Bachelor's degree and at least 2 years of relevant experience, with oncology experience preferred. The employer offers competitive salaries and a comprehensive benefits package including

Qualifications

• Bachelor's degree in a relevant field or equivalent.
• Minimum of 2 years of relevant experience.
• Oncology - Preferred.

Responsibilities

• Adhere and perform 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 by reviewing the treatment plan, serves as a resource to provide education regarding payer policies and assists with coordination of alternative treatment options
• Ensures and Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.
• Proactive communication with leadership regarding barriers and or potential delays in care Identifies opportunities for expedited requests and prioritizes caseload accordingly
• Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
• This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

Education

Bachelor's degree in relevant field

Job description

University of Miami Health System is seeking a full-time Utilization Review Case Manager to work remotely. The role conducts initial and concurrent chart reviews for utilization and authorization, coordinating with the healthcare team to ensure timely patient care and minimize delays.

The position requires a Bachelor's degree and at least 2 years of relevant experience, with oncology experience preferred. The employer offers competitive salaries and a comprehensive benefits package including