Remote Utilization & Care Coordination Specialist

University of Miami; Miami (FL); Remote; USD 55,000 - 75,000; Full time

Job summary

The University of Miami Health System is seeking a remote Utilization Case Manager to oversee ongoing reviews for continued authorization and coordinate with the Nursing Case Manager and healthcare team. This full-time staff role requires at least a bachelor’s degree and a minimum of two years of relevant experience, with a focus on payer criteria and clinical guidelines.

You will maintain clear communication with the clinical team and patients to prevent delays and denials while ensuring

Qualifications

• Bachelor’s degree or equivalent is required.
• Minimum of 2 years of relevant experience.
• Strong knowledge of authorization processes and payer policies.

Responsibilities

• Adhere to and perform timely reviews for services requiring continuation of care authorization.
• Follow the authorization process using payer criteria and clinical guidelines.
• Accurate review of coverage benefits and limitations to determine continued appropriateness; facilitate interdepartmental communication.
• Maintain communication regarding authorization status with the clinical team and patient.
• Identify potential delays in treatment by reviewing the treatment plan and communicating barriers.
• Maintain knowledge of payer reimbursement policies and clinical guidelines.
• Adhere to University and department policies and safeguard assets.

Education

Bachelor’s degree in relevant field

Minimum of 2 years of relevant experience

Job description

The University of Miami Health System is seeking a remote Utilization Case Manager to oversee ongoing reviews for continued authorization and coordinate with the Nursing Case Manager and healthcare team. This full-time staff role requires at least a bachelor’s degree and a minimum of two years of relevant experience, with a focus on payer criteria and clinical guidelines.

You will maintain clear communication with the clinical team and patients to prevent delays and denials while ensuring