Utilization Review Specialist RN

BayCare Health System; Tampa (FL); Hybrid; USD 85,000 - 120,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Tuition reimbursement

401k match

Yearly performance bonus

Community discounts

Job summary

BayCare Health System is seeking a Senior Utilization Review RN for St. Joseph’s Hospital in Tampa. This hybrid, full-time role covers 8:00 AM–4:30 PM on weekdays with three weekend days per month and no on-call requirements.

The ideal candidate has 3+ years of RN experience, with Utilization Review and Case Management background, and preferred ACM/CCM certifications. Associates or BSN required, MSN/MBa preferred.

Qualifications

• Required Associates in Nursing or Bachelor’s in Nursing
• Preferred Masters in Nursing or Business
• Required 2 years in Utilization Review
• Required 2 years in Case Management
• Required 3 years Registered Nurse
• Preferred experience in Critical Care or Emergency Service
• Certifications: RN required; ACM and CCM preferred

Responsibilities

• 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

Skills

RN

Case Management

Utilization Review

Critical Care

Emergency Nursing

Education

Associate degree in Nursing

Bachelor of Science in Nursing

Master's in Nursing or Business (preferred)

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
• Status: Full Time, Exempt
• Schedule: Monday - Friday 8:00 AM - 4:30 PM
• Weekend Requirement: 3 weekend days per month (week days will adjusted on those weeks)
• 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