Remote Utilization Case Manager

About the role

UMHC‑SCCC Business Operations is seeking a full‑time Remote Utilization Case Manager. The role involves conducting ongoing clinical utilization reviews and determining the need for continued authorizations to support optimal patient outcomes.

Key responsibilities

• Perform timely reviews of services requiring authorization for continued care.
• Follow payer and clinical guidelines to assess coverage benefits and appropriateness.
• Accurately evaluate coverage limitations and determine continued service eligibility.
• Facilitate inter‑departmental communication regarding authorization status before patient appointments.
• Communicate authorization determinations to the clinical team and, when appropriate, to patients.
• Identify potential treatment delays by reviewing plans and proactively notifying the healthcare team.
• Maintain up‑to‑date knowledge of payer reimbursement policies and clinical guidelines.
• Adhere to university and departmental policies while safeguarding assets.

Required profile

• Bachelor’s degree in a relevant field or equivalent experience.
• Minimum of two years of experience in utilization review, case management, or a related healthcare role.

What we offer

• Competitive salary package.
• Comprehensive benefits including medical, dental, and tuition remission.
• Opportunity to work within the University of Miami Health System, a leading academic medical center.