Oncology Utilization Review RN — Denial Mitigation

Moffitt Cancer Center; Tampa (FL); On-site; USD 77,000 - 118,000; Full time

Job summary

Moffitt Cancer Center in Florida is seeking an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews to determine medical necessity, appropriate level of care, and continued stay in accordance with payer and regulatory requirements.

This role supports efficient utilization and denial mitigation through collaboration with Case Management, Physician Advisors, providers, and payers in an acute oncology setting.

Qualifications

• Knowledge of utilization management principles and medical necessity determination.
• Ability to analyze clinical documentation and apply established criteria.
• Organizational skills with attention to detail and deadlines.
• Proficiency with electronic medical records and standard office software.

Responsibilities

• Perform initial, concurrent, and retrospective utilization reviews to determine medical necessity and appropriate level of care.
• Collaborate with Case Management, Physician Advisors, providers, and payers to support denial prevention and effective appeals.
• Serve as a clinical resource in utilization management within the acute oncology setting.

Skills

Clinical docs analysis

Utilization management

Denial mitigation

EMR proficiency

Collaboration

Time management

Education

Associate's Degree

Bachelor's Degree

Job description

Moffitt Cancer Center in Florida is seeking an Utilization Review Nurse to perform initial, concurrent, and retrospective reviews to determine medical necessity, appropriate level of care, and continued stay in accordance with payer and regulatory requirements.

This role supports efficient utilization and denial mitigation through collaboration with Case Management, Physician Advisors, providers, and payers in an acute oncology setting.