Utilization Case Manager Rn (h)

University of Miami

Miami, Florida, United States
Not specified; competitive salary offered; compreh...
Prospective review of medical necessity
Knowledge of payer policies and guidelines
Effective communication with clinical teams
The primary purpose of this role is to conduct initial chart reviews for medical necessity and identify the need for authorization to ensure optimal patient outcomes

Job Summary

  • The primary purpose of this role is to conduct initial chart reviews for medical necessity and identify the need for authorization to ensure optimal patient outcomes.
  • The Utilization Case Manager RN serves as a subject matter expert, providing education and support to the team regarding payer policies and treatment barriers.
  • The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, and tuition remission.

Matching Summary

The primary purpose of this role is to conduct initial chart reviews for medical necessity and identify the need for authorization to ensure optimal patient outcomes.

Salary

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

Skills & Requirements

Must-have

  • Prospective review of medical necessity
  • Knowledge of payer policies and guidelines
  • Effective communication with clinical teams
  • Coordination of alternative treatment options
  • Adherence to established clinical criteria

Nice-to-have

  • Ability to work independently under pressure
  • Subject matter expertise in utilization management
  • Strong organizational and prioritization skills
  • Collaborative approach to patient outcomes

Key Requirements

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

Work Rights

Not specified

Tailored Resume

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