Utilization Case Manager Rn (h)

University of Miami

Miami, Florida, United States
Not specified; not specified; comprehensive benefi...
Not specified (likely onsite based on the nature of the role)
Prospective review of medical services
Knowledge of payer policy limitations
Clinical guidelines and compendia usage
The University of Miami is seeking a Utilization Case Manager RN to perform chart reviews for medical necessity, coordinate patient care, and communicate effectively with healthcare teams to ensure optimal patient outcomes. The ideal candidate should possess a Bachelor’s degree in Nursing, a valid RN license, and at least two years of relevant experience

Job Summary

  • The Utilization Case Manager RN conducts initial chart reviews for medical necessity and identifies 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 University of Miami is seeking a Utilization Case Manager RN to perform chart reviews for medical necessity, coordinate patient care, and communicate effectively with healthcare teams to ensure optimal patient outcomes. The ideal candidate should possess 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
  • Clinical guidelines and compendia usage
  • Interdepartmental communication coordination
  • Patient barrier identification

Nice-to-have

  • Subject matter expert support skills
  • Collaborative environment experience
  • Critical decision making ability
  • Effective oral and written communication

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