Oncology Utilization Review RN — Care Optimization

SPEROS; Tampa, Northern (FL, KY); Hybrid; USD 77,000 - 118,000; Full time

Job summary

Moffitt Cancer Center in Tampa, FL seeks an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews ensuring medical necessity and appropriate care levels. You will collaborate with case management, physician advisers, providers, and payers to support appropriate resource use and effective appeals.

Minimum education includes an Associate's Degree in Nursing with RN licensure; a Bachelor's in Nursing is preferred.

Qualifications

• RN license required with knowledge of utilization management principles.
• Ability to analyze clinical documentation and apply criteria.
• Ability to work independently and collaborate with teams.
• Strong organizational skills and attention to deadlines.
• Proficiency with EMR and standard office software.

Responsibilities

• Perform initial, concurrent, and retrospective utilization reviews.
• Determine medical necessity and appropriate level of care.
• Collaborate with Case Management, Physician Advisors, providers, and payers.
• Contribute to denial mitigation within the oncology setting.

Skills

Utilization management

Medical necessity

Denial mitigation

Clinical documentation analysis

EMR proficiency

Teamwork / collaboration

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (preferred)

Tools

Electronic Medical Records (EMR)

Job description

Moffitt Cancer Center in Tampa, FL seeks an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews ensuring medical necessity and appropriate care levels. You will collaborate with case management, physician advisers, providers, and payers to support appropriate resource use and effective appeals.

Minimum education includes an Associate's Degree in Nursing with RN licensure; a Bachelor's in Nursing is preferred.