Case Manager Registered Nurse, Utilization Review - Per Diem
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The University of Miami is currently seeking a per diem Utilization Case Manager, RN to work at Sylvester Support Service Building in Miami.
The incumbent coordinates the overall interdisciplinary plan of care for patients, from admission to discharge.
The Utilization Case Manager, RN also provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient's needs.
An employee in this position acts as a liaison between patients, families, and healthcare personnel to ensure necessary care is provided promptly and effectively.
Core Job Functions Adhere and perform timely prospective reviews for services requiring prior authorization 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 in recommended compendia and or guidelines Serves as a resource to provide education regarding payer policies and facilitates coordination of alternative treatment options Ensures and maintains effective communication regarding prior authorization status and determination to the clinical team and on occasion the patient.
7.
Facilitates interdepartmental communication regarding authorization status in advance of the patient's appointment 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 Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
Adheres to University and department level policies and procedures and safeguards University assets.
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.
MINIMUN QUALIFICATIONSEducation Graduate from an accredited school of nursing, Bachelor's degree (BSN) Certification and Licensing Registered Nurse License; Basic Life Support Certification (BLS) from the American Heart Association.
Experience Minimum 2 years of relevant experience 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.
Patient safety is a top priority.
As a result, during the Influenza (the flu) season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination.
Failure to meet this requirement will result in rescinding or termination of employment.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply.
Applicants and employees are protected from discrimination based on certain categories protected by Federal law.
Click here for additional information.
Job StatusPart timeEmployee TypeTemporaryPay Graden7 Recommended Skills Advanced Cardiovascular Life Support (Acls) Basic Life Support Certified Nurse Practitioner Clinical Works Communication Nursing Estimated Salary: $20 to $28 per hour based on qualifications.
To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet.
The University of Miami is currently seeking a per diem Utilization Case Manager, RN to work at Sylvester Support Service Building in Miami.
The incumbent coordinates the overall interdisciplinary plan of care for patients, from admission to discharge.
The Utilization Case Manager, RN also provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient's needs.
An employee in this position acts as a liaison between patients, families, and healthcare personnel to ensure necessary care is provided promptly and effectively.
Core Job Functions Adhere and perform timely prospective reviews for services requiring prior authorization 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 in recommended compendia and or guidelines Serves as a resource to provide education regarding payer policies and facilitates coordination of alternative treatment options Ensures and maintains effective communication regarding prior authorization status and determination to the clinical team and on occasion the patient.
7.
Facilitates interdepartmental communication regarding authorization status in advance of the patient's appointment 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 Maintains knowledge regarding payer reimbursement policies and clinical guidelines.
Adheres to University and department level policies and procedures and safeguards University assets.
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.
MINIMUN QUALIFICATIONSEducation Graduate from an accredited school of nursing, Bachelor's degree (BSN) Certification and Licensing Registered Nurse License; Basic Life Support Certification (BLS) from the American Heart Association.
Experience Minimum 2 years of relevant experience 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.
Patient safety is a top priority.
As a result, during the Influenza (the flu) season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination.
Failure to meet this requirement will result in rescinding or termination of employment.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply.
Applicants and employees are protected from discrimination based on certain categories protected by Federal law.
Click here for additional information.
Job StatusPart timeEmployee TypeTemporaryPay Graden7 Recommended Skills Advanced Cardiovascular Life Support (Acls) Basic Life Support Certified Nurse Practitioner Clinical Works Communication Nursing Estimated Salary: $20 to $28 per hour based on qualifications.
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