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. CORE JOB SUMMARY The purpose of the Utilization Case Manager RN is to conduct initial chart reviews for medical necessity and identify the need for authorization. The Utilization Case Manager RN coordinates with the healthcare team for optimal and efficient patient outcomes, while avoiding potential treatment delays and authorization denials. They are accountable for a designated patient caseload and provide intervention and coordination to decrease avoidable delays. At all times they provide communication of progress and or determination to the clinical team and or the patient as it pertains to treatment or treatment barriers. Finally, the nurse serves as the subject matter expert to her team, providing support and education. CORE JOB FUNCTIONS 1. Adhere and perform timely prospective reviews for services requiring prior authorization 2. Follows the authorization process using established criteria as set forth by the payer or clinical guidelines 3. Accurate review of coverage benefits and payer policy limitations to determine appropriateness of requested services 4. Refers to the treatment plan for clinical reviews in accordance with established criteria in recommended compendia and or guidelines 5. Serves as a resource to provide education regarding payer policies and facilitates coordination of alternative treatment options 6. Ensures and maintains effective communication regarding prior authorization status and determination to the clinical team and on occasion the patient. 7. Facilitates interdepartmental communication regarding authorization status in advance of the patient’s appointment 8. Identifies potential delays in treatment by reviewing the treatment plan and proactively communicates with the healthcare team and or patient regarding the potential treatment barrier 9. Maintains knowledge regarding payer reimbursement policies and clinical guidelines. 10. Adheres to University and department 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 Nursing Certification and Licensing: Registered Nurse License; Basic Life Support Certification (BLS). Core_Utilization Case Manager RN Experience: Minimum 2 years of relevant experience Knowledge, Skills and Attitudes: • Ability to exercise sound judgment in making critical decisions. • Skill in completing assignments accurately and with attention to detail. • Ability to analyze, organize and prioritize work under pressure while meeting deadlines. • Ability to work independently and/or in a collaborative environment. • Ability to communicate effectively in both oral and written form. 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. Job Status: Full time Employee Type: Staff

Position Summary The Care Coordination Manager (CCM) provides comprehensive care coordination to people with intellectual and developmental disabilities (I/DD) within small, local regions of New York State. CCMs oversee a caseload of people with I/DD, acting as a main support to each member, their families, and advocates. The CCM coordinates and monitors all aspects of a member’s life including medical, behavioral health, and community service options. Ensuring access to services and informed choice are essential components in the provision of care coordination. The core responsibility of a CCM is to develop and help oversee a Life Plan with each member. The Life Plan is a person-centered plan that puts the aspirations and desires of each member at the forefront of every decision that impacts a member’s life. Care managers ensure that individualization, integration, independence, and productivity are emphasized in all aspects of life for Southern Tier Connect members. This position is Monday-Friday with allowance for flexible hours to accommodate for employee family and personal life. STC’s CCM positions are tele-commute, meaning you can earn a competitive salary with generous paid time off, receive great benefits including a 401K match up to 5%, and make a difference in the lives of people with I/DD in your area, all from the comfort of your own home. The Care Coordination Manager must meet the requirements of the Care Coordination Organization/IDD Health Home, including 6 core areas of Health Home requirements and skill building areas. Primary Duties and Responsibilities: - Complete comprehensive assessments - Development and continual review of an individualized plan of care (Life Plan) through a person centered planning process - Co-identification of interdisciplinary team; contact and scheduling team meetings - Understand each caseload member’s interests, needs, and desires so that each person has the opportunity to reach their potential for independence. - Ensure eligibility for Medicaid and all other identified benefits for applicable services (Behavioral, Medical, HCBS etc.) are maintained. - Utilize CQL/ Personal Outcome Measures interview techniques and processes to inform interdisciplinary team and Life Plan. - Comprehensive and continuous linkage to OPWDD, behavioral, health and community supports and services. - Monitor health and safety of the person and ensure 624/633 and subpart 635-9 is followed. - Work with families, advocates, and individuals as appropriate so that they are fully informed of choice and given opportunity for input in all aspects of care being provided. - Emphasize consumer satisfaction at all stages of program planning and review. - Provide accurate, thorough, and timely documentation according to OPWDD and CCO Policies and Procedures. - Ensure enrollees’ rights are honored and that individualization is a priority. - Utilize a variety of electronic systems to maintain documentation and communication. - Ensure records are compliant, and all documentation and service standards are met, including the timely completion of activity notes and Life Plans - Ensure required training hours are completed. - Other duties as assigned Qualifications, Skills and Knowledge Requirements: - Bachelor’s degree with two years of relevant experience, or - A Master’s degree with one year of relevant experience. - License as a Registered Nurse with two years of relevant experience - A valid Driver’s License - Must be able to work a flexible schedule and use personal vehicle for business travel purposes. - Ability to work with diverse populations and treat all people with dignity and respect - Duties require professional verbal and written communication skills. - Proficiency in or knowledge of using a variety of computer software and e-mail applications, especially Microsoft Excel, Outlook and Word; have the aptitude to learn other computer software as necessary. Southern Tier Connect is an equal opportunity employer. It is the policy of Southern Tier Connect to prohibit discrimination and harassment of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, creed, gender, marital status, sexual orientation, national origin or citizenship, age, genetic predisposition or carrier status, gender identity or expression, disability, military or veteran status, sexual or reproductive health decisions, traits historically associated with race and/or any other status or characteristic protected by law.

Company Description About Sutherland: Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise. We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence. We’ve created over 200 unique inventions under several patents across AI and other critical technologies. Leveraging our advanced products and platforms, we drive digital transformation, optimize critical business operations, reinvent experiences, and pioneer new solutions, all provided through a seamless “as a service” model. For each company, we provide new keys for their businesses, the people they work with, and the customers they serve. We tailor proven and rapid formulas, to fit their unique DNA. We bring together human expertise and artificial intelligence to develop digital chemistry. This unlocks new possibilities, transformative outcomes and enduring relationships. Sutherland Unlocking digital performance. Delivering measurable results Job Description Sutherland is looking to add an Independent Claims Adjuster's license Team Manager - (Remote) - to our team. If you feel you're ready for the next step in your career, and have passion for coaching & mentoring others, we want to hear from you! As a Team Manger you will get to: - Impact the Bottom Line: Drive the performance of a team of Consultants, meeting and exceeding all KPI targets. - Strengthen Relationships: Manage attrition, shrinkage, and other critical metrics of the team. - Influence the Lives of Others: Coach and mentor Consultants, providing feedback and performance management. - Keep Management Updated: Inform leadership on the latest trends of end-user customers and provide feedback to Ops Managers. - Define Sutherland's Reputation: Drive organizational initiatives within the team from time to time. Qualifications Qualifications: - Must hold a current, active Claims Adjuster License in good standing for at least 2 years - Minimum 1 year of experience managing claims adjusters in a licensed adjuster capacity - Be able to work in MS Office - Be able to work in a fast-paced environment - Be pro-active in developing trust and professional rapport with employees and team members; work as a team-player - Have strong analytical skills; be able to interpret data, identify trends, and make suggestions for improvements - Have strong verbal and written communication skills; be able to communicate in a clear, constructive, and professional manner Additional Information All your information will be kept confidential according to EEO guidelines. EEOC and Veteran Documentation During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.

Company Description About Sutherland: Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they’re our core expertise. We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence. We’ve created over 200 unique inventions under several patents across AI and other critical technologies. Leveraging our advanced products and platforms, we drive digital transformation, optimize critical business operations, reinvent experiences, and pioneer new solutions, all provided through a seamless “as a service” model. For each company, we provide new keys for their businesses, the people they work with, and the customers they serve. We tailor proven and rapid formulas, to fit their unique DNA. We bring together human expertise and artificial intelligence to develop digital chemistry. This unlocks new possibilities, transformative outcomes and enduring relationships. Sutherland Unlocking digital performance. Delivering measurable results Job Description Sutherland is looking to add an Independent Claims Adjuster's license Team Manager - (Remote) - to our team. If you feel you're ready for the next step in your career, and have passion for coaching & mentoring others, we want to hear from you! As a Team Manger you will get to: - Impact the Bottom Line: Drive the performance of a team of Consultants, meeting and exceeding all KPI targets. - Strengthen Relationships: Manage attrition, shrinkage, and other critical metrics of the team. - Influence the Lives of Others: Coach and mentor Consultants, providing feedback and performance management. - Keep Management Updated: Inform leadership on the latest trends of end-user customers and provide feedback to Ops Managers. - Define Sutherland's Reputation: Drive organizational initiatives within the team from time to time. Qualifications Qualifications: - Must hold a current, active Claims Adjuster License in good standing for at least 2 years - Minimum of 2 years of experience managing a team - Be able to work in MS Office - Be able to work in a fast-paced environment - Be pro-active in developing trust and professional rapport with employees and team members; work as a team-player - Have strong analytical skills; be able to interpret data, identify trends, and make suggestions for improvements - Have strong verbal and written communication skills; be able to communicate in a clear, constructive, and professional manner Additional Information All your information will be kept confidential according to EEO guidelines. EEOC and Veteran Documentation During employment, employees are treated without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status. At times, government agencies require periodic reports from employers on the sex, ethnicity, handicap, veteran and other protected status of employees. The purpose of this Administrative EEO Record is for statistical analysis only and is used to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Administrative EEO record is optional. If you choose to volunteer the requested information, please note that all Administrative EEO Records are kept in a Confidential File and are not part of your Application for Employment or Personnel file. Please note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.