Utilization Review Specialist RN

Baycare; Tampa (FL); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Health, Dental, Vision

Paid time off

Tuition reimbursement

401k match and yearly contribution

Performance bonuses

Community discounts

Job summary

BayCare in Tampa, FL is seeking a Senior Utilization Review Specialist who will act as the primary liaison between funding agents and care teams to ensure medical necessity for outpatient observation and inpatient stays.

The role requires RN licensure and prior utilization review or case management experience.

Qualifications

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

Responsibilities

• Serve as primary liaison between funding agents and care teams to ensure medical necessity for outpatient observation and inpatient stays
• Coordinate and review concurrent utilization and denials as assigned by supervisor
• Contribute to care coordination with emphasis on Critical Care or Emergency services when applicable

Skills

Utilization Review

Case Management

Registered Nurse

Education

Bachelor's in Nursing

Associate in Nursing

Master's in Nursing or Business

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
• 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