Utilization Review Specialist Senior

Baycare; Tampa (FL); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

401k match

Community discounts

Job summary

BayCare in Tampa, FL invites an experienced Utilization Review Senior RN for a PRN/hybrid role at St. Josephs. You will coordinate care with funding agents, perform concurrent reviews for medical necessity of outpatient observation and inpatient stays, and handle concurrent denials as needed.

Strong RN background with case management preferred; requires 2+ years in utilization review or case management. This position offers hybrid work at St.

Qualifications

• RN licensure with active state license
• ACM (Case Management) preferred
• CCM (Case Manager) preferred

Responsibilities

• Act as primary liaison between funding agents and care teams to ensure appropriate level of care
• Conduct comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays
• Process concurrent denials as needed
• Perform other duties as assigned by supervisor

Skills

Utilization Review

Case Management

Critical Care

Emergency Nursing

Education

Associates in Nursing

Bachelor in Nursing

Masters in Nursing or Business

Job description

Tampa:St Josephs | Clinical | PRN

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.
• Location: Hybrid - St Josephs Hospital/Tampa, FL
• Status: PRN, As Needed
• Schedule: 8:00 - 4:30 PM
• Orientation: Full time
• 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
• 401k match and additional yearly contribution
• Community discounts and more

Equal Opportunity Employer Veterans/Disabled