Case Manager Utilization Review

Tampa General Hospital; Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare facility in Florida is seeking a fully remote Utilization Review Case Manager. This role involves validating patient placements, conducting reviews, and engaging with payers for service authorizations. Candidates must hold a Florida RN license and have at least three years of experience as a practicing RN. The role emphasizes collaboration with healthcare professionals and effective communication. A full-time position, it offers a starting salary of $36.41 per hour with a flexible work schedule.

Qualifications

• Graduate of an accredited school of nursing.
• Florida state RN license is required.
• Experience in a health care setting preferred.

Responsibilities

• Manage and validate patient placement at the appropriate level of care.
• Conduct admission and concurrent reviews as necessary.
• Collaborate with payers for service authorizations.

Skills

RN license

3 years experience as a practicing RN

HMO/Managed Care experience

Communication skills

Education

Associates Degree in Nursing

Job description

Job Summary

Utilization & Utilization Review Case Manager validating patient placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools to complete initial and continued stay reviews, determining appropriate level of patient care, appropriateness of tests/procedures, and estimating the patient’s expected length of stay. The UR Case Manager secures authorization for the patient’s clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with CMS Conditions of Participation for Utilization Review. Under general supervision of the Utilization Management Manager, the Utilization Management Nurse monitors and manages all inpatient hospital admissions with the goal of achieving cost‑effective patient care, identifying situations where criteria are not met for admission and discussing issues with the attending physician, utilizing clinical skills, chart review, physician communication and Interqual Level of Care, and peer review as necessary. The UR Case Manager follows established policies, procedures and professional guidelines while working closely with Resource Center Associates, Care Coordinators, Nursing and Physicians to obtain clinical information to justify proposed services and care; establishes strong relationships with Managed Care Organizations to enhance the ability to obtain authorizations for services; liaises with the manager and reports all situations requiring management intervention; performs job functions in accordance with mission, vision and values of Tampa General Hospital. The primary areas of responsibilities are: concurrent utilization review, retrospective and/or denials management and interactions with department and staff of TGH to ensure good patient flow through appropriate status and medical necessity designations.

Duties

• Admission Reviews
• Concurrent Reviews
• Case Escalations for appropriate status
• Concurrent Denials Management Interdisciplinary discussions and physician partnerships
• Graduate of an accredited school of nursing; Associates Degree Required, z
• Florida state RN license
• Three (3) years as a practicing RN
• At least two (2) years’ experience in a health care setting
• HMO/Managed Care/Medicare/Medicaid experience preferred.

Primary Location

Tampa

Work Locations

TGH Corporate Center

Eligible for Remote Work

Fully Remote

Job

Quality/Utilization Management

Organization

Florida Health Sciences Center Tampa General Hospital

Schedule

Full-time

Scheduled Days

Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday

Shift

Day Job

Job Type

Remote

Shift Hours

Day Shift

Minimum Salary

36.41

Job Posting

Feb 9, 2026, 3:52:23 PM