Job Title:   Case Manager RN / Utilization Management
Pay Grade:   9
Pay Band Min / Max:    - 
Position Number:   046711

The University of Miami Miller School of Medicine-UHealth is home to some of the brightest minds in the world. Our Faculty teach students who represent the future of medicine. Our researchers are discovering breakthrough patient treatments. 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 subspecialties, and have more than one million patient encounters each year.

UMHC Sylvester Utilzation Management Department is currently seeking a Case Manager, RN.
Acts as a patient advocate/case manager to hospital clients. Coordinates, negotiates, procures services and resources for, and manages, the care of complex patients. Facilitates the achievement of quality healthcare and cost efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective, quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care.

Minimum Requirements are: • Current State of Florida RN License Required • Bachelor’s degree in Nursing required. • BLS certification required. • Three years of relevant nursing experience required, acute care, critical care or emergency department experience required. • Case Management or Utilization Management experience preferred. • Demonstrated skills in the areas of negotiation, communication (verbal and written). • Conflict resolution, interdisciplinary collaboration, management, creative problem solving and critical thinking. • Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis. • Experience in understanding and usage of computers as well as the ability to learn applications relevant to the position. • Knowledge of utilization management as it relates to third-party payers • Ability to successfully function in a fast paced, service oriented environment. • Strong time management and organizational skills with attention to detail. Any appropriate combination of relevant education, experience and/or certifications will be considered.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the groundbreaking research and medical education at the Miller School of Medicine. University of Miami Hospital is the flagship facility of UHealth, which also includes the Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute, along with dozens of outpatient facilities. 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 - 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.

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