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Remote Weekend Utilization Review Jobs in Florida

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Remote Weekend Utilization Review information

What is the difference between Remote Weekend Utilization Review vs Remote Weekday Utilization Review?

AspectRemote Weekend Utilization ReviewRemote Weekday Utilization Review
CredentialsTypically requires a healthcare professional license and utilization review certificationSame as weekend role, healthcare license and utilization review certification
Work EnvironmentRemote, weekend hours, often part-time or flexibleRemote, weekday hours, standard business hours
Employer & IndustryHealth insurance companies, third-party administratorsSame as weekend role, health insurance industry
Work SchedulePrimarily weekends, possibly eveningsWeekdays, regular business hours

Remote Weekend Utilization Review and Remote Weekday Utilization Review roles are similar in credentials and industry but differ mainly in work schedule. Weekend roles focus on reviewing cases during weekends, offering flexibility, while weekday roles follow standard business hours. Both positions require healthcare licensing and utilization review certification, serving health insurance companies and third-party administrators.

What cities in Florida are hiring for Remote Weekend Utilization Review jobs? Cities in Florida with the most Remote Weekend Utilization Review job openings:
Remote Weekend Utilization Review jobs near you
Oncology Prior Authorization Case Manager, Non-RN - Remote

Oncology Prior Authorization Case Manager, Non-RN - Remote

The University of Miami

Miami, FL • On-site, Remote

Full-time

Medical, Dental

Posted 5 days ago

University Of Miami rating

7.7

Company rating: 7.7 out of 10

Based on 52 frontline employees who took The Breakroom Quiz

217th of 539 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 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

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