Utilization Case Manager (remote)

University of Miami

Miami, FL, United States
Fully remote
Ongoing clinical utilization reviews
Identify need for continued authorization
Coordinate with nurse case manager
The University of Miami is seeking a full-time remote Utilization Case Manager responsible for overseeing clinical utilization reviews and ensuring continued authorization for patient care. This role involves coordinating with healthcare teams to facilitate optimal patient outcomes and effective communication regarding authorization status

Job Summary

  • The incumbent is to complete ongoing reviews for clinical utilization and identifying the need for continued authorization.
  • The Utilization Case Manager coordinates with the Nurse Case Manager as well as the Healthcare team for optimal patient outcomes, while avoiding potential treatment delays and authorization denials.
  • The Utilization Case Manager is accountable for a designated patient caseload and ensures that all necessary criteria for continued authorization remains in place.

Matching Summary

Match Score: 85

The University of Miami is seeking a full-time remote Utilization Case Manager responsible for overseeing clinical utilization reviews and ensuring continued authorization for patient care. This role involves coordinating with healthcare teams to facilitate optimal patient outcomes and effective communication regarding authorization status.

Skills & Requirements

Must-have

  • Ongoing clinical utilization reviews
  • Identify need for continued authorization
  • Coordinate with Nurse Case Manager
  • Communicate progress to clinical team

Nice-to-have

  • Proactive communication of treatment barriers
  • Maintain knowledge of payer policies

Key Requirements

  • Bachelor’s degree in relevant field or equivalent
  • Minimum of 2 years of relevant experience

Work Rights

Not specified

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