RN Utilization Review - Full Time Days

About the role

As a Utilization Review Nurse at Moffitt, you will perform initial, concurrent, and retrospective utilization reviews to determine medical necessity, appropriate level of care, and continued stay in accordance with payer, regulatory, and accreditation requirements. This role supports appropriate resource utilization, denial prevention, and effective appeal outcomes through collaboration with Case Management, Physician Advisors, providers, and payers. You will serve as a clinical resource in utilization management and denial mitigation within the acute care oncology setting.

Responsibilities

• Conduct initial, concurrent, and retrospective utilization reviews to assess medical necessity and appropriate level of care.
• Collaborate with Case Management, Physician Advisors, providers, and payers to support resource utilization and denial prevention.
• Analyze clinical documentation and apply established criteria for utilization management.
• Serve as a clinical resource for denial mitigation in an acute care oncology environment.
• Work independently while effectively engaging with interdisciplinary teams.
• Manage tasks with attention to detail and deadlines.
• Utilize electronic medical records and standard office software proficiently.

Requirements

• Associate’s Degree in Nursing (Bachelor’s Degree preferred).
• Active Registered Nurse (RN) licensure.
• Knowledge of utilization management principles, medical necessity determination, and denial mitigation.
• Ability to analyze clinical documentation and apply established criteria.
• Strong organizational skills with attention to detail and deadline management.
• Proficiency with electronic medical records and standard office software.

Preferred Qualifications

• Bachelor’s Degree in Nursing.
• Basic Life Support (BLS) certification.
• CCM or ACM certification.

Pay

Salary range: $77,022.40 – $117,582.40. Actual compensation may vary based on location, experience, skills, education, and internal equity.