Utilization Case Manager Rn (h)

University of Miami

Miami, FL, US
Not specified; not specified; comprehensive benefi...
Not specified
Prospective review of medical services
Knowledge of payer policy limitations
Effective communication with clinical teams
The University of Miami is seeking a Utilization Case Manager RN who will conduct initial chart reviews for medical necessity and coordinate patient care to optimize outcomes while minimizing treatment delays. The ideal candidate should have a Bachelor’s degree in Nursing, a valid RN license, and at least two years of relevant experience

Job Summary

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

Matching Summary

Match Score: 85

The University of Miami is seeking a Utilization Case Manager RN who will conduct initial chart reviews for medical necessity and coordinate patient care to optimize outcomes while minimizing treatment delays. The ideal candidate should have a Bachelor’s degree in Nursing, a valid RN license, and at least two years of relevant experience.

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
  • Effective communication with clinical teams

Nice-to-have

  • Subject matter expertise in utilization management
  • Ability to work independently under pressure
  • 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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