Summary
The Utilization Review Nurse is responsible for performing 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. The Utilization Review Nurse serves as a clinical resource in utilization management and denial mitigation within the acute care oncology setting.
Job Title: Utilization Review Nurse
Minimum Education Level: Associate's Degree
Minimum Field of Study: Nursing
Minimum Education Notes:
Preferred Education Level: Bachelor's Degree
Preferred Field of Study: Nursing
Preferred Education Notes:
Licensure Certification Needed: Yes
Minimum Licensure: Registered Nurse (RN)
Minimum Licensure (Other):
Training Required: Knowledge of utilization management principles, medical necessity determination, and denial mitigation.Ability to analyze clinical documentation and apply established criteria.Ability to work independently while collaborating effectively with interdisciplinary teams.Organizational skills with attention to detail and deadline management.Proficiency with electronic medical records and standard office software.
Preferred Licensure: Basic Life Support (BLS)Other (If other, please enter details in section to the right)Other (If other, please enter details in section to the right)
Preferred Licensure (Other): CCMACM
Salary Range
$77,022.40 - $117,582.40
Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions.
We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce.
Moffitt Career Site
1. Equal Employment Opportunity
Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.
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