University of Miami
Oncology Prior Authorization Case Manager, Non-RN - Remote
Miami, FL · Staff+ · Contract
Sponsorship not specifiedDetected 2 days ago
HRISPatient CareResearchLeadershipCommunication
About the role
- 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.
Responsibilities
- Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of care services
- Ensures and Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.
Requirements
- Bachelor's degree in relevant field
- Minimum of 2 years of relevant experience
Nice to have
- Oncology - Preferred
Benefits
- Accurate review of coverage benefits and payer policy limitations to determine appropriateness of requested services
- Facilitates communication of denials and or Peer to Peer requests between payers and the healthcare team
- Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
- 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.
Company info
- As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean.
Equal opportunity
- The University of Miami is an Equal Opportunity Employer.
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