Utilization Case Manager (H)

University of Miami•Miami, FL

23h

About The Position

UMHC-SCCC has an exciting opportunity for a Utilization Case Manager position. 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. At all times the case manager provides communication of progress and or determination to the clinical team and or the patient.

Requirements

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

Responsibilities

Adhere and perform 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 continued appropriateness of services requested
Facilitates interdepartmental communication regarding status of continued 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 healthcare 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 all-inclusive and may be expanded to include other duties or responsibilities as necessary.