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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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| Aspect | Full Time Remote Rn | Part Time Remote Rn |
|---|---|---|
| Work Hours | Typically 35-40 hours per week | Less than 30 hours per week |
| Salary & Benefits | Full benefits, consistent salary | Pro-rated pay, limited benefits |
| Job Responsibilities | Complete full scope of nursing duties | Same duties but with flexible hours |
| Work Environment | Home-based, remote | Home-based, remote |
Full Time Remote Rn roles offer a consistent schedule, full benefits, and a stable income, ideal for those seeking full-time employment. Part Time Remote Rn positions provide flexibility with fewer hours and limited benefits, suitable for individuals balancing other commitments. Both roles allow remote work, but differ mainly in hours and compensation structure.

Oncology Prior Authorization Case Manager, Non-RN - Remote
The University of MiamiMiami, FL • On-site, Remote
Full-time
Medical, Dental
Posted 7 days ago
University Of Miami rating
7.7
Based on 52 frontline employees who took The Breakroom Quiz
209th of 528 rated colleges and universities
Job description
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 time
Employee Type:
Staff
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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