RN Utilization Review - Full Time Days

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

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

Minimum Education Notes:

Preferred Education Level: Bachelor's Degree

Preferred Field of Study: Nursing

Preferred Education Notes:

Licensure Certification Needed: Yes

Minimum Licensure: Registered Nurse (RN)

Minimum Licensure (Other):

• 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

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.

Reasonable Accommodation

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Moffitt endeavors to make moffitt.org/careers accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact one of the Human Resources receptionists by phone at 813-745-7899 or by email at [e-mail]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. Read more information about yourEEO rights under the law.

Transparency in Coverage Rule Careers

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.