Manager Utilization Review (Nurse Manager) Case Management Baptist Hospital of Miami Full-Time, 8:30A-5P
Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with more than 23,000 employees working across 11 hospital campuses and more than 100 outpatient facilities throughout Miami-Dade, Monroe, Broward, and Palm Beach counties. In 2016 we welcomed the newest weapon in the fight against cancer, the world-class Miami Cancer Institute and proton therapy center.
You will collaborate with all members of the health care delivery team to enhance the provision of patient care services and ensures reimbursement for services provided from admission to discharge. Serves as a resource to the hospital for utilization management, regulatory and denial issues; interfaces with third party payers and BHSF Patient Financial Services department; and manages the Denial and Appeals Coordinators and retrospective review process.
Minimum 5 years experience required.
Bachelor’s degree and Florida RN license required.
Certification and experience in U/R Case Management or Quality Management.
Three years experience in denial and appeals process.
Knowledge of reimbursement principles, Medicare/Medicaid regulations, InterQual and/or MCG.
Advanced communication and interpersonal skills and excellent organizational skills including effective time management, collaboration, priority setting and process improvement.
Demonstrates leadership ability, professionalism and integrity.
Baptist Health South Florida is once again one of the 2019 Fortune 100 Best Companies to Work For! This is the 19th time Baptist Health has been recognized on the list. We have also been recognized for being among the best healthcare providers in the nation by U.S. News & World Reports in its 2019-2020 Best Hospitals and have been honored as one of PEOPLE’s 2019 50 Companies that Care by PEOPLE magazine and Great Place to Work.
Baptist Health is an Equal opportunity Employer. This position is not open to any third party recruiters, consultants and/or vendors at this time.
Internal Number: 87646
About Baptist Health South Florida
Baptist Health South Florida is the largest faith-based, not-for-profit health care organization in the region. Its network of services supported by more than 16,000 employees extends throughout Miami-Dade, Broward, Palm Beach and Monroe Counties. Our facilities include Baptist Hospital, Baptist Children’s Hospital, Doctors Hospital, Fishermen’s Community Hospital, Homestead Hospital, Mariners Hospital, South Miami Hospital, West Kendall Baptist Hospital and the Miami Cancer Institute; outpatient diagnostic and surgical facilities, such as our Baptist Medical Plazas and home health care services in the region.
The Miami Cancer Institute and proton therapy center will usher in a new era of innovative, precision cancer treatment that is unmatched in South Florida today. Our not-for-profit facility is on track to bring nationally renowned oncology experts to what will become a world-class destination for patients from across the U.S., the Caribbean and Latin America.
Our International Center of Miami is one of the largest hospital-based international programs in America. Thousands of people each year travel to Miami from around the world to visit our respected physicians and our medical facilities.