Case Manager RN - Utilization Review

About the Role

Case Manager RN - Utilization Review at University of Miami in Anywhere. Benefits: health benefits.

Key Responsibilities

• 1. Adhere and perform timely prospective reviews for services requiring prior authorization.
• 4. Refers to the treatment plan for clinical reviews in accordance with established criteria in recommended compendia and or guidelines.
• 5. Serves as a resource to provide education regarding payer policies and facilitates coordination of alternative treatment options.
• 9. Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
• Working knowledge of patient assessment, and medical terminology.

Requirements

• Graduate from an accredited school of nursing, Bachelor’s degree (BSN).
• Certification and Licensing:
• Valid State of Florida RN license required
• Basic Life Support Certification (BLS) from the American Heart Association required.
• Experience:
• Minimum 2 years of relevant experience required. Minimum of one 1 year in Hospital Case Management/nursing.

Benefits & Compensation

• Work Location: UHealth Tower
• 8. 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.
• Learning Agility: Ability to learn new procedures, technologies, and protocols, and adapt to changing priorities and work demands.
• The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.