Utilization Review Registered Nurse

BayCare Health System; Tampa (FL); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Tuition reimbursement

401k match

Job summary

BayCare Health System in Tampa, FL seeks a Utilization Review Senior Registered Nurse to liaise between funding agents and care teams, ensuring medical necessity for outpatient observation and inpatient stays.

The hybrid, full-time role at St. Joseph's Hospital requires RN licensure and 2+ years in utilization review or case management, with preferred experience in critical care or emergency services. Benefits include health/dental/vision, PTO, tuition reimbursement and a 401(k) match.

Qualifications

• Requires RN licensure with 2+ years in utilization review or case management.
• Experience in Critical Care or Emergency Nursing preferred.
• Hybrid role at St Josephs Hospital in Tampa.

Responsibilities

• Functions as liaison between funding agents and care teams to ensure medical necessity for outpatient observation and inpatient stays.
• Perform concurrent reviews for outpatient and inpatient stays and utilization of ancillary services.
• Process concurrent denials as assigned by supervisor.
• Collaborate with care teams to optimize utilization and discharge planning.

Skills

RN

Case Management

Utilization Review

Education

Associates in Nursing

Bachelors in Nursing

Masters in Nursing or Business

Job description

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

Position Utilization Review Registered Nurse

Location Tampa:St Josephs | Clinical | PRN

Req ID 178022