Remote Utilization Case Manager — Authorization & Clinical Coordination

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

Job summary

University of Miami Health System seeks a Full-time, remote Utilization Case Manager to conduct ongoing reviews for clinical utilization and determine continued authorization. The role coordinates with the Nurse Case Manager and healthcare team to support timely patient care and avoid delays.

This position manages a designated caseload, communicates progress to the clinical team and patient, and adheres to payer guidelines and internal policies.

Qualifications

• Bachelor’s degree in relevant field; or equivalent.
• Minimum of 2 years of relevant experience.
• Knowledge of utilization management processes and payer guidelines.

Responsibilities

• Perform timely reviews for services requiring authorization for continuation of care.
• Follow the authorization process using established criteria from the payer or clinical guidelines.
• Review coverage benefits and limitations to determine continued appropriateness of services.
• Communicate status of authorization to clinical team and the patient as needed.
• Identify potential delays in treatment and proactively communicate with the healthcare team and patient.

Education

Bachelor’s degree in relevant field; or equivalent

Job description

University of Miami Health System seeks a Full-time, remote Utilization Case Manager to conduct ongoing reviews for clinical utilization and determine continued authorization. The role coordinates with the Nurse Case Manager and healthcare team to support timely patient care and avoid delays.

This position manages a designated caseload, communicates progress to the clinical team and patient, and adheres to payer guidelines and internal policies.