RN Utilization Review - Full Time Days

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

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer.

As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces.

Summary

The Utilization Review Nurse is responsible for performing initial, concurrent, and retrospective utilization reviews to determine medical necessity, appropriate level of care, and continued stay in accordance with payer, regulatory, and accreditation requirements. This role supports appropriate resource utilization, denial prevention, and effective appeal outcomes through collaboration with Case Management, Physician Advisors, providers, and payers. The Utilization Review Nurse serves as a clinical resource in utilization management and denial mitigation within the acute care oncology setting.

Job Title:

Utilization Review Nurse

Minimum Education Level:

Associate's Degree

Minimum Field of Study:

Nursing

Preferred Education Level:

Bachelor's Degree

Preferred Field of Study:

Nursing

Licensure Certification Needed:

Yes

Minimum Licensure:

Registered Nurse (RN)

Minimum Experience Required:

Three (3) years of experience as a Case Manager in an acute setting with two (2) of those years focusing on utilization review.

Training Required:

Knowledge of utilization management principles, medical necessity determination, and denial mitigation. Ability to analyze clinical documentation and apply established criteria. Ability to work independently while collaborating effectively with interdisciplinary teams. Organizational skills with attention to detail and deadline management. Proficiency with electronic medical records and standard office software.

Preferred Licensure:

Basic Life Support (BLS)Other (If other, please enter details in section to the right)Other (If other, please enter details in section to the right)

Preferred Licensure (Other):

CCMACM

Salary Range:

$77,022.40 - $117,582.40

Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions.

We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce.

Moffitt Career Site

If you have the vision, passion, and dedication to contribute to our mission, then we have a place for you!

• Equal Employment Opportunity: Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.
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