Utilization Review Registered Nurse

Baycare; Tampa (FL); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Tuition reimbursement

401k match

Annual bonus

Job summary

BayCare, a major healthcare provider in the Tampa Bay area, seeks an experienced Utilization Review Specialist Senior (RN) for our hybrid St. Joseph's Hospital location in Tampa, FL.

The role focuses on ensuring appropriate care levels through concurrent reviews and collaboration with funding agents. The position requires an RN license with 2–3 years in utilization review or case management, and preferred ACM/CCM certifications.

Qualifications

• Requires RN licensure and hospital-based nursing experience.
• Preferred certifications ACM or CCM in case management.
• Education: ADN or BSN required; Masters preferred in Nursing or Business.

Responsibilities

• Serve as primary liaison between funding agents and care teams to ensure appropriate level of care and medical necessity.
• Handle concurrent reviews and potential denials; support processing denials as needed.
• Preferred background in Critical Care or Emergency Nursing to inform utilization decisions.

Skills

Utilization review

Case management

RN license

Nursing experience

Education

Associates in Nursing

Bachelors in Nursing

Masters in Nursing or Business

Tools

ACM (Case Management)

CCM (Case Manager)

Job description

Details

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area.Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

The Utilization Review Specialist Senior responsibilities include:

• Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services
• Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials.
• Preferred experience includes Critical Care or Emergency Nursing RN.

Position details:

• Location: Hybrid - St Josephs Hospital - Tampa, FL
• Orientation: full time and onsite for up to 2 months
• Status: PRN, As Needed
• Schedule: 8:00 AM - 4:30.
• Looking for weekday availability and every 3rd weekend
• Some Weekdays and every 3rd weekend availability
• On Call: No

Certifications and Licensures:

• Required RN (Registered Nurse)
• Preferred ACM (Case Management)
• Preferred CCM (Case Manager)

Education:

• Required Associates in Nursing or
• Required Bachelors in Nursing
• Preferred Masters in Nursing or Business

Experience:

• Required 2 years in Utilization Review or
• Required 2 years in Case Management or
• Required 3 years Registered Nurse
• Preferred experience in Critical Care or Emergency Service

Benefits:

• Benefits (Health, Dental, Vision)
• Paid time off
• Tuition reimbursement
• 401k match and additional yearly contribution
• Yearly performance appraisals and team award bonus
• Community discounts and more

Equal Opportunity Employer Veterans/Disabled