The mission of the University of Miami is to transform lives through education, research, innovation, and service. A vibrant and diverse academic and healthcare community, the University of Miami and the University of Miami Health System ("UHealth") have rapidly progressed to become one of the nation’s top research universities and academic medical centers in the nation. The University comprises 12 schools and colleges serving undergraduate and graduate students in more than 350 majors and programs. Visit welcome.miami.edu/about-um to learn more about our points of pride. The University ranks No. 55 on U.S. News & World Report’s 2022 Best Colleges list and ranked No. 49 in the 2022 Wall Street Journal/Times Higher Education College Rankings. Bascom Palmer Eye Institute is ranked the #1 eye hospital in the USA and offers some of the nation's premiere eye doctors to treat every eye condition for adults. Sylvester Comprehensive Cancer, part of the Miller School of Medicine, received the prestigious National Cancer Institute designation in 2019. The University of Miami and UHealth have also ranked among the Forbes Best Employers and Best Employers for Women on several occasions, most recently in 2022. Transforming lives With more than 17,000 faculty and staff, the University strives for excellence, and is driven by a powerful mission to transform and impact the lives of its students, patients, members of the community, and people across the globe. The University is committed to fostering a culture of belonging, where everyone feels valued and has the opportunity to add value. Through values of Diversity, Integrity, Responsibility, Excellence, Compassion, Creativity, and Teamwork (DIRECCT) the U community works together to create an environment driven by purpose, excellence, community, and service. 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 using the Career worklet, please review this tip sheet. The University of Miami has an exciting opportunity for a Case Manager for the Stem Cell Transplant Clinical Program at Sylvester Cancer Center. The Case Manager coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. The incumbent 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. The core job responsibilities of the role are the following: Coordinates the integration of the social services function into patient care. Assists patients in understanding their conditions and possible medical treatments. Works with affiliated agencies and acts as an advocate between service recipients and these agencies. Designs health plans for patients, which contain several activities from administering medication to consulting with other healthcare personnel. Collaborates with other professionals to evaluate patients' medical or physical conditions and relevant needs. Identifies environmental impediments to client or patient progress through interviews with patients and review of patient records. Monitors, evaluates, and records client progress per measurable goals described in treatment and care plan. Utilizes consultation data and social work experience to plan and coordinate patient care and rehabilitation, following through to ensure service efficacy. Adheres to University and unit-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. CORE QUALIFICATIONS: Education: Bachelor’s degree in relevant field Experience: Minimum 3 years of relevant experience Knowledge, Skills and Attitudes: Skill in completing assignments accurately and with attention to detail. Ability to analyze, organize and prioritize work under pressure while meeting deadlines. Ability to process and handle confidential information with discretion. Ability to work evenings, nights, and weekends as necessary. Commitment to the University’s core values. Ability to work independently and/or in a collaborative environment. Department Specific Job Functions: Reviews the medical records of all outpatient, observation and inpatient admissions to determine medical necessity for admission and continued stay, using pre-established criteria on a daily basis. Continued review of all patients using criteria and determines need for continued hospitalization based upon third party payer/insurance guidelines. 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. 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. Participates in interdisciplinary patient care rounds to review care plan and treatment goals, facilitates cost-effective utilization of patient services, and ensure that appropriate referrals are initiated. Establishes a means of communicating and collaborating with physicians, other team members, the patient’s payers, and administrators. Explores strategies to reduce length of stay and resource consumption within the care-managed patient populations, implements them, and documents the results. Communicates to appropriate members of healthcare team the patients at risk of losing insurance coverage via termination of benefits and facilitates discharge plan. Maintains a proactive role to ensure appropriate documentation concurrently to minimize inefficient resource utilization and prevent loss of reimbursement. Reviews physician documentation and, when needed, follows procedures to seek clarification of documentation relative to diagnosis and comment, on the patient’s clinical state. Maintains current knowledge of case management, utilization management, and discharge planning, as specified by federal, state, and private insurance guidelines. 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. Provides utilization review and clinical assessment of all requests for admissions of bone marrow transplant patients based on medical necessity. Authorize admissions when appropriate. 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. 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. 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. Obtains pre-certification, authorizations, from medical review insurance companies and/or designated payors and initiates Letters of Medical Necessity when requested. 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. Determines patient’s eligibility for financial clearance for Stem Cell Transplant based on criteria utilizing patient’s financial information provided. 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 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. 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 Status: Full time Employee Type: Staff Pay Grade: c105