Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Case Management, Utilization Management, Discharge Planning, Medical Necessity Review, Financial Clearance
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Radiographic Equipment Operation, Aseptic Technique, Radiation Protection, Patient Monitoring, Life Support Measures
MIKA Coral GablesCoral Gables, Florida, United States · On-site
At MIKA Coral Gables by Michael White, we are committed to delivering exceptional Mediterranean-inspired cuisine with precision, creativity, and genuine hospitality. The Pastry Cook / Line Cook is responsible for prepari…
Skills: Fine dining execution, Food safety and sanitation, Knife skills, Time management, Organization
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: CT Scanning, Radiographic Equipment Operation, Patient Positioning, IV Insertion, Contrast Administration
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Data entry, Patient scheduling, Insurance verification, Medical record review, Triage
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Laboratory Experiments, Research Protocols, Specimen Analysis, Tissue Culture, Statistical Analysis
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Clinical Trial Management, Ophthalmic Testing, Manuscript Writing, IRB Compliance, Patient Recruitment
Coral Gables, Florida, United States · On-site
Job Description: Our Opportunity: At Chewy Vet Care, we’re changing the veterinary care experience! With the launch of our new veterinary practices, we are looking for a full-time Practice Manager to join our Healthcare …
Skills: Practice Management, Staff Management, Conflict Resolution, Inventory Management, Client Relations
Coral Gables, Florida, United States · On-site
Founded in 2003, Kanner & Pintaluga is a NLJ500 and Mid-Market Pro 50 law firm that has recovered over $1 billion for property damage and personal injury clients nationwide. With nearly 100 lawyers and more than 30 offic…
Skills: Litigation Support, E-filing, Legal Drafting, Case Management, Microsoft Office Suite
Coral Gables, Florida, United States · On-site
$120k–$160k/yr
Description Miami, FL (South Florida) Full-Time | On-Site Miami-Dade & Broward Residential Construction Senior-Level Position About the Role We are a high-end luxury custom home builder operating throughout South Florida…
Skills: Construction Management, Luxury Residential Construction, Subcontractor Coordination, Budget Management, Scheduling
Coral Gables, Florida, United States · On-site
Description About the Company: Inter Miami CF (IMCF or the Club) is a Major League Soccer club competing in the Eastern Conference, owned by Miami Beckham United and playing at its newly developed permanent stadium (Nu S…
Skills: Procurement Policy, Strategic Sourcing, Vendor Management, Source-to-Pay (S2P), Cost Reduction
Coral Gables, Florida, United States
About Gulliver Preparatory School Gulliver is a leading school of distinction, founded in 1926 and rooted in a century of educational excellence. To this day, our mission remains unchanged: to create an academic communit…
Coral Gables, Florida, United States · On-site
Benefits We Offer Include: Medical, Dental & Vision Insurance401(k) with company matchEmployer‑paid life & disability insuranceFlexible Spending Accounts (FSA)Paid Time Off (PTO)7 Company Paid Holidays24/7 Telemedicine &…
Skills: Program Management, Stakeholder Management, Data Analysis, Business Insights, Advanced Excel
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Customer Service, Problem Solving, Record Keeping, Confidentiality, Learning Agility
Coral Gables, Florida, United States · On-site
$10/hr–$25/hr
Salary Range $10.00 - $25.00* Job Description: WHO WE ARE: Neiman Marcus is a leading luxury retailer that provides a curated product assortment, unparalleled services, and exclusive activations for customers in Pursuit …
Skills: Luxury Selling, Customer Service, Styling, Digital Selling Tools, Client Relationship Management
Coral Gables, Florida, United States · On-site
Position Summary The Group Fitness Instructor provides cutting-edge group fitness instruction through a variety of entertaining, educational, and fun classes promoting fitness and positive self-esteem in a safe environme…
Skills: Group Fitness Instruction, Exercise Programming, Member Relationship Management, CPR/AED, Fitness Coaching
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Onboarding, I-9 Compliance, Workday, Data Analysis, Interpersonal Communication
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Customer Service, Problem Solving, Written Communication, Verbal Communication, Technical Proficiency
Coral Gables, Florida, United States · On-site
Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty…
Skills: Clinical Research Coordination, Patient Recruitment, Informed Consent, Data Collection, Chart Review
Coral Gables, Florida, United States · On-site
LEGENDS GLOBAL & THE UNIVERSITY OF MIAMI The University of Miami is in a long-term partnership with Legends to oversee athletics ticket sales, customer service, annual fund solicitation/engagement, ticket operations, dig…
Skills: Sales Leadership, Revenue Generation, Premium Sales, Business Development, Group Sales
Coral Gables, Florida, United States • On-site
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The Case Manager reviews medical records to determine medical necessity for admissions and manages the utilization of healthcare resources. They coordinate financial clearance for stem cell transplant patients and collaborate with multidisciplinary teams to facilitate efficient discharge planning.
The candidate must have knowledge of federal, state, and private insurance guidelines regarding case and utilization management. Proficiency in managing financial screenings and coordinating clinical appointments within a healthcare system is required.
Current Employees:
If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet.
1. Reviews the medical records of all outpatients, observation, and inpatient admissions to determine medical necessity for
admission and continued stay, using pre-established criteria on a daily basis.
2. Continued review of all patients using criteria and determines need for continued hospitalization based upon third party
payer/insurance guidelines.
3. Provides clinical data/information to contracted third-party payers while patient is hospitalized to ensure continued
reimbursement and to avoid reimbursement delays within 24 hours of request.
4. Interacts, communicates, and intervenes with multidisciplinary healthcare team in a purposeful, goal-directed fashion.
Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates, and facilitates problem
resolution around issues of resource use and continued hospitalization and discharge planning.
a. Participates in interdisciplinary patient care rounds to review care plan and treatment goals, facilitates costeffective
utilization of patient services, and ensures that appropriate referrals are initiated.
b. Establishes a means of communicating and collaborating with physicians, other team members, the patient’s
payers, and administrators.
c. Explores strategies to reduce length of stay and resource consumption within the care-managed patient
populations, implements them, and documents the results.
d. Communicates to appropriate members of healthcare team the patients at risk of losing insurance coverage via
termination of benefits and facilitates discharge plan.
e. Maintains a proactive role to ensure appropriate documentation concurrently to minimize inefficient resource
utilization and prevent loss of reimbursement.
f. Reviews physician documentation and, when needed, follows procedures to seek clarification of documentation
relative to diagnosis
Core_Utilization Case Manager - SCT - new August 1 2023 updated per DC.HR
5. Maintains current knowledge of case management, utilization management, and discharge planning, as specified by
federal, state, and private insurance guidelines.
6. Optimizes use of time by efficiently using resources to identify barriers and balance priorities. Efficiently utilizes tools,
resources, techniques, and/or systems to organize tasks. Balance multiple priorities simultaneously, ensuring the timely
and accurate completion of each task while maintaining quality standards.
7. Develops criteria to financially screen potential BMT patients, evaluate and determine if a patient is eligible for financial
clearance for transplant, and maintain an electronic log of eligible and non-eligible patients. The individual will be expected
to access, analyze, and guide all potential adult stem cell transplant candidates through the transplant financial process.
8. Ensures all staff members adhere to all established policies and procedures related to the business operations and
continuously monitors compliance. Responsible for correcting actions that are out of compliance.
9. Schedules and registers patients and donors as per established policies and procedures in UChart as required.
Coordinates clinical appointments with nurses, physicians, physical therapists, and technician in order to maximize patient
access to inpatient and outpatient BMT program.
10. Obtains pre-certification, authorizations, from medical review insurance companies and/or designated payors and initiates
Letters of Medical Necessity when requested.
11. Obtains required patient/guarantor signatures where applicable and counsels patients and/or surrogates to explain their
particular coverage benefits and financial responsibilities available through their specific healthcare plans throughout the
transplant process.
12. Determines patient’s eligibility for financial clearance for Stem Cell Transplant based on criteria utilizing patient’s financial
information provided.
13. Ensures accurate billing of services is rendered and ensures collections of all co-payments, co-insurance amounts,
deductibles, and non-covered amounts for both Hospital & Professional prior to procedure by establishing system to track
compliance. Addresses all financial inquiries, regarding patient accounts, potential new referrals for hospital services, and
coordination of same with departments involved with case or pertinent outside healthcare entity
14. Consults with Transplant Coordinators, and the Adult Stem Cell Transplant Attending Physicians regarding the financial
status of the transplant patient referral for financial approval or denial for the transplant program.
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.
The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.
Offices: 5915 PONCE DE LEON BLVD, Coral Gables, Florida 33146, us
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