Utilization Review Registered Nurse

BayCare Health System; Tampa (FL); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

PTO

Tuition reimbursement

401k match

Job summary

BayCare Health System is seeking a Senior Utilization Review Nurse in Tampa for a hybrid role at St. Joseph's Hospital. The position is full-time and onsite for up to two months, with ongoing PRN schedule requirements including weekday and every third weekend, 8:00 AM–4:30 PM, and no on-call duties.

Required RN licensure (Assoc/BSN), with preferred ACM/CCM credentials and 2–3 years in Utilization Review or Case Management. Experience in Critical Care or Emergency Service is a plus.

Qualifications

• 2+ years in Utilization Review or Case Management.
• 3 years RN experience.
• Preferred experience in Critical Care or Emergency Service.

Responsibilities

• Acts as primary liaison between funding agents and related parties for medical necessity of outpatient observation, inpatient stays and services.
• Processes concurrent denials and other duties as assigned by supervisor.
• Supports RN in critical care or emergency settings as needed.

Skills

Utilization review

Case management

Nursing

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.

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