Utilization Case Manager Rn (h)

med.miami.edu

Miami, Florida, United States
Not specified; not specified; comprehensive benefi...
Not specified
Prospective chart review for medical necessity
Prior authorization process management
Payer policy and benefit analysis
The University of Miami is seeking a full-time Utilization Case Manager RN to manage patient caseloads and ensure timely authorizations for medical services. The role requires a strong nursing background, critical thinking skills, and effective communication to enhance patient care and minimize delays

Job Summary

  • The Utilization Case Manager RN is responsible for conducting initial chart reviews to determine medical necessity and identify authorization needs.
  • This role serves as a subject matter expert to the clinical team, providing education on payer policies and facilitating alternative treatment options.
  • The University of Miami Health System 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 full-time Utilization Case Manager RN to manage patient caseloads and ensure timely authorizations for medical services. The role requires a strong nursing background, critical thinking skills, and effective communication to enhance patient care and minimize delays.

Salary

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

Skills & Requirements

Must-have

  • Prospective chart review for medical necessity
  • Prior authorization process management
  • Payer policy and benefit analysis
  • Clinical guideline adherence
  • Interdepartmental communication coordination

Nice-to-have

  • Subject matter expert in payer policies
  • Ability to work under pressure
  • Strong oral and written communication skills
  • Collaborative team environment experience

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