... work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for ... Adhere and perform timely prospective review for services requiring prior authorization as well as ...
... work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for ... Adhere and perform timely prospective review for services requiring prior authorization as well as ...
... work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for ... Adhere and perform timely prospective review for services requiring prior authorization as well as ...
... work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for ... Adhere and perform timely prospective review for services requiring prior authorization as well as ...
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Remote Facebook Ads Expert
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Saint Petersburg, FL · On-site +1
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CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses ... prior authorization, complex pre-payment medical review or post-payment medical review. ESSENTIAL ...
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CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses ... prior authorization, complex pre-payment medical review or post-payment medical review. ESSENTIAL ...
Intake Specialist
Boca Raton, FL · Remote
$16.75 - $22.50/hr
Ensure all required elements are obtained prior to benefits investigation and authorization ... Location: Remote with limited travel to client locations, internal business meetings, and other ...
Intake Specialist
Boca Raton, FL · Remote
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Ensure all required elements are obtained prior to benefits investigation and authorization ... Location: Remote with limited travel to client locations, internal business meetings, and other ...
Intake Specialist
Boca Raton, FL · On-site +1
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Tampa, FL · Remote
$20/hr
... prior authorizations. This position liaises between departments payors and providers to ... remote position. Application Deadline This position is anticipated to close on Sep 11, 2026. About ...
Insurance/Reimbursement Specialist
Tampa, FL · Remote
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Obtain prior authorizations and pre-certifications for in-home nursing services for a dedicated ... Hybrid/Remote What we Offer: * A supportive and collaborative work environment. * Opportunity to ...
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Working closely with operational leaders across Claims, Prior Authorization, Utilization Management ... Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. Hybrid ...
Working closely with operational leaders across Claims, Prior Authorization, Utilization Management ... Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. Hybrid ...
Remote / Freelancer Contract This posting is city-anchored for job board distribution, but ... Prior experience in customer support, call center, help desk, or technical support. - Ability to ...
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Telemedicine Physician Medical Weight Management
Miami, FL · Remote
$195K - $225K/yr
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Quick apply
Telemedicine Physician Medical Weight Management
Miami, FL · Remote
$195K - $225K/yr
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Remote - USA • What you'll do: End-to-End Technical Integration Delivery * Lead end-to-end design ... Revenue cycle systems, prior authorization systems * Proficient in configuring and troubleshooting ...
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Telemedicine Physician Medical Weight Management
West Palm Beach, FL · Remote
$195K - $225K/yr
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Quick apply
Telemedicine Physician Medical Weight Management
West Palm Beach, FL · Remote
$195K - $225K/yr
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Telemedicine Physician Medical Weight Management
Fort Lauderdale, FL · Remote
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Location: Remote (United States) Type: Full-Time, Part-Time, or 1099 Compensation: $195,000-$255 ... Document thoroughly to support prior authorization and continuity of care What We Offer * Multi ...
Quick apply
Telemedicine Physician Medical Weight Management
Fort Lauderdale, FL · Remote
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Location: Remote (United States) Type: Full-Time, Part-Time, or 1099 Compensation: $195,000-$255 ... Document thoroughly to support prior authorization and continuity of care What We Offer * Multi ...
Maps Quality Rater - English Fluency
Clearwater, FL · Remote
$20.30/hr
An active Gmail user with prior Google Maps usage history PROJECT DETAILS * Location: Remote (United States) * Employment Type: Freelance * Language: English (Fluent) * Estimated Commitment: 8-10 ...
Quick apply
Maps Quality Rater - English Fluency
Clearwater, FL · Remote
$20.30/hr
An active Gmail user with prior Google Maps usage history PROJECT DETAILS * Location: Remote (United States) * Employment Type: Freelance * Language: English (Fluent) * Estimated Commitment: 8-10 ...
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Oncology Prior Authorization Case Manager, Non-RN - Remote
Miami, FL • On-site, Remote
Full-time
Medical, Dental
Re-posted 23 days ago
University Of Miami rating
7.7
Based on 52 frontline employees who took The Breakroom Quiz
264th of 631 rated colleges and universities
Job description
Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet.
The University of Miami Health System Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for optimal and efficient patient outcomes, while avoiding treatment delays and authorization denials. They are accountable for a designated patient caseload and provide intervention and coordination to decrease avoidable delays, at all times they provide communication of progress and or determination to the clinical team and or the patient. He/she monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates for the best outcome to meet ongoing patient needs that encourages compliance with medical advice.
CORE FUNCTIONS:
Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of care services
Follows the authorization process using established criteria as set forth by the payer or clinical guidelines
Accurate review of coverage benefits and payer policy limitations to determine appropriateness of requested services
Refers to the treatment plan for clinical reviews in accordance with established criteria and guidelines
Facilitates communication of denials and or Peer to Peer requests between payers and the healthcare team
Identifies potential delays in treatment or inappropriate utilization by reviewing the treatment plan, serves as a resource to provide education regarding payer policies and assists with coordination of alternative treatment options
Ensures and Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.
Proactive communication with leadership regarding barriers and or potential delays in care Identifies opportunities for expedited requests and prioritizes caseload accordingly
Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
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.
CORE QUALIFICATIONS:
Education:
Bachelor's degree in relevant field; or equivalent
Experience:
Minimum of 2 years of relevant experience
Oncology - Preferred
Any relevant education, certifications and/or work experience may be considered
The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
UHealth-University of Miami 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 University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.
Job Status:
Full timeEmployee Type:
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About University of Miami
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The University of Miami, located in the beautiful Coral Gables, Florida, is a comprehensive, private research institution in the United States. Operating within the higher education industry, the institution offers a multitude of degree programs spanning over 180 majors and program through its 12 colleges. The University was founded in 1925 with the mission to disseminate knowledge, transform lives, and change the world - a mission it has held faithfully to this day. Notably, the University of Miami has gained global recognition for its commitment to research and innovation, with over $324 million in research and sponsored project funding awarded annually.
Industry
Colleges, universities, and professional schools
Company size
10,000+ Employees
Headquarters location
Coral Gables, FL, US
Year founded
1925