Not specified; not specified; comprehensive benefi...
Prospective review of services requiring prior authorization
Accurate review of coverage benefits and payer policy limitations
Knowledge of clinical guidelines and recommended compendia
The Utilization Case Manager RN coordinates with the healthcare team for optimal and efficient patient outcomes while avoiding potential treatment delays
Job Summary
The Utilization Case Manager RN coordinates with the healthcare team for optimal and efficient patient outcomes while avoiding potential treatment delays.
This role requires adherence to established criteria set forth by payers or clinical guidelines to determine the appropriateness of requested services.
The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
Matching Summary
The Utilization Case Manager RN coordinates with the healthcare team for optimal and efficient patient outcomes while avoiding potential treatment delays.
Salary
Not specified; Not specified; Comprehensive benefits package including medical, dental, tuition remission
Skills & Requirements
Must-have
Prospective review of services requiring prior authorization
Accurate review of coverage benefits and payer policy limitations
Knowledge of clinical guidelines and recommended compendia
Effective communication with clinical team and patients
Proactive identification of potential treatment barriers
Nice-to-have
Ability to learn new procedures and adapt to changing priorities
Collaborative teamwork in a healthcare environment
Strong written and verbal communication skills
Skilled in using office software and relevant computer applications
Key Requirements
Bachelor's degree (BSN) from accredited school of nursing
Valid State of Florida RN license required
Basic Life Support Certification (BLS) from American Heart Association
Minimum 2 years of relevant experience required
Minimum 1 year in Hospital Case Management/nursing