Remote Utilization Case Manager - Continuity of Care

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

Benefits offered by this job

Medical benefits

Tuition remission

Remote work flexibility

Job summary

The University of Miami is seeking a Full-time Utilization Case Manager for a remote role within UMHC-SCCC - Business Operations. The incumbent will complete ongoing reviews for clinical utilization and determine the need for continued authorization, coordinating with the Nurse Case Manager and healthcare team to avoid delays.

Requires a Bachelor's degree in a relevant field (or equivalent) and a minimum of 2 years of related experience.

Qualifications

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

Education

Bachelor’s degree in relevant field; or equivalent

Job description

The University of Miami is seeking a Full-time Utilization Case Manager for a remote role within UMHC-SCCC - Business Operations. The incumbent will complete ongoing reviews for clinical utilization and determine the need for continued authorization, coordinating with the Nurse Case Manager and healthcare team to avoid delays.

Requires a Bachelor's degree in a relevant field (or equivalent) and a minimum of 2 years of related experience.