Utilization Case Manager

Job not on LinkedIn

🕒 September 28

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 18%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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University of Miami

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1925

🏥 Healthcare

📚 Education

💰 $1M Grant on 2023-02

Healthcare • Education

University of Miami is a prestigious private research university located in Coral Gables, Florida. It offers a wide range of undergraduate, graduate, and professional degree programs through its numerous schools and colleges, including the School of Architecture, College of Arts and Sciences, and Miami Herbert Business School among others. The university is recognized for its contributions to research, particularly in areas such as marine and atmospheric science through the Rosenstiel School, as well as in medicine through the Miller School of Medicine. The institution is also noted for its vibrant student life, with a strong emphasis on athletics and community engagement. University of Miami is committed to fostering an inclusive educational environment and is home to a diverse student body from around the globe.

📋 Description

• Complete ongoing reviews for clinical utilization and identify the need for continued authorization • Coordinate with the Nurse Case Manager and healthcare team for optimal patient outcomes • Manage a designated patient caseload and ensure criteria for continued authorization remain in place • Perform timely reviews for services requiring authorization for continuation of care • Follow authorization processes using established payer criteria or clinical guidelines • Review coverage benefits and limitations to determine continued appropriateness of requested services • Facilitate interdepartmental communication regarding continued authorization status before patient appointments • Communicate authorization status and determinations to clinical teams and patients • Identify potential treatment delays by reviewing treatment plans and proactively communicate treatment barriers • Maintain knowledge of payer reimbursement policies and clinical guidelines • Adhere to University and department policies and procedures and safeguard University assets

🎯 Requirements

• Bachelor’s degree in relevant field; or equivalent • Minimum of 2 years of relevant experience • Knowledge of payer reimbursement policies and clinical guidelines • Ability to follow authorization processes using established payer criteria or clinical guidelines • Ability to review coverage benefits and limitations • Ability to coordinate with nurse case managers and healthcare teams • Ability to communicate authorization status and determinations to clinical teams and patients • Ability to identify potential treatment delays and authorization barriers • Ability to adhere to University and department policies and procedures

🏖️ Benefits

• Competitive salaries • Comprehensive benefits package including medical, dental, tuition remission and more