Care Manager Utilization Review

As Mount Sinai grows, so does our legacy in high-quality health care.

Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital,dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring: The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Position Responsibilities:

Conducts concurrent clinical review applying Interqual criteria to justify the patient's admission and continued stay                        If case fails Interqual criteria based on the available documentation, conducts an in-depth review of past hospital admissions and/or office records to identify medical history and comorbid conditions that may justify the need for inpatient admission and/or continued stayCommunicates with Payor Specialists to identify possible denials promptly and provides additional information to reverse the concurrent denial as appropriate; refers cases to the PA if neededAssesses patient's discharge readiness and identifies delays in patient care, delays due to lack of community resources and/or barriers delaying the patient's dischargeDocuments all identified delays appropriately Promotes accuracy and completeness of clinical documentation to reflect the appropriateness of services being provided; reports any identified trends/common requests to managementProvides coverage to other areas in the department, including but not limited to observation review, Medicaid review, and appeals for denied casesParticipates in weekend rotation and on-call as requiredDemonstrates sufficient computer skills to perform job function; checks voicemail and email as instructed by leadership and as warranted Promotes a service orientation in the performance of position duties and responsibilities and in interactions with patients, hospital staff, and visitors

Qualifications:

AA degree in nursing or other related discipline. Bachelors Degree preferredMinimum of 3 years previous Care Management experience. 

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:

Health benefitsLife insuranceLong-term disability coverageHealthcare spending accountsRetirement planPaid time offPet InsuranceTuition reimbursementEmployee assistance programWellness programOn-site housing for selected positions and more! Share