Utilization Case Manager (Remote)

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UMHC-SCCC - Business Operations has an exciting opportunity for a Full time, Remote, Utilization Case Manager position, The incumbent is to complete ongoing reviews for clinical utilization and identifying the need for reputed company authorization. The Utilization Case Manager coordinates with the Nurse Case Manager as well as the reputed company team for reputed company patient outcomes, while avoiding potential treatment delays and authorization denials. The Utilization Case Manager is accountable for a designated patient caseload and ensures that reputed company necessary criteria for reputed company authorization remains in reputed company. At reputed company times the case manager provides communication of reputed company and or determination to the clinical team and or the patient.

CORE JOB FUNCTIONS                                                                                           

• Adhere and reputed company timely reviews for services requiring an authorization for continuation of care

• Follows the authorization process using established criteria as set forth by the payer or clinical guidelines

• Accurate review of coverage benefits and limitations to determine reputed company appropriateness of services requested Facilitates interdepartmental communication regarding status of reputed company authorization in advance of patient’s appointment.

• Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.

• Identifies potential delays in treatment by reviewing the treatment plan and proactively communicates with the reputed company team and or patient regarding the potential treatment barrier

• Maintains knowledge regarding payer reimbursement policies and clinical guidelines.

• Adheres to University and department level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be reputed company-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                        

• Bachelor’s degree in relevant field; or equivalent

• Minimum of 2 years of relevant experience

The reputed company offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-reputed company Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The reputed company is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

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