Utilization Case Manager Rn (h)

University of Miami

Miami, Florida, US
Not specified; not specified; comprehensive benefi...
Prospective review of medical services
Knowledge of payer policy limitations
Clinical guidelines interpretation
The Utilization Case Manager RN conducts initial chart reviews for medical necessity to identify the need for authorization

Job Summary

  • The Utilization Case Manager RN conducts initial chart reviews for medical necessity to identify the need for authorization.
  • This role coordinates with the healthcare team to ensure optimal patient outcomes while avoiding potential treatment delays and authorization denials.
  • The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, and tuition remission.

Matching Summary

Match Score: 85

The Utilization Case Manager RN conducts initial chart reviews for medical necessity to identify the need for authorization.

Salary

Not specified; Not specified; Comprehensive benefits package including medical, dental, tuition remission

Skills & Requirements

Must-have

  • Prospective review of medical services
  • Knowledge of payer policy limitations
  • Clinical guidelines interpretation
  • Interdepartmental communication coordination
  • Treatment plan barrier identification

Nice-to-have

  • Subject matter expert support provision
  • Education on alternative treatment options
  • Collaborative work environment adaptability
  • Sound judgment in critical decisions

Key Requirements

  • Bachelor's degree in Nursing
  • Registered Nurse License
  • Basic Life Support Certification (BLS)
  • Minimum 2 years relevant experience

Work Rights

Not specified

Tailored Resume

Cover Letter