Top 74 Utilization review rn Jobs in Tampa Fl

Case Manager, RN- Utilization Review
Tampa General Hospital —Tampa, FL
- $36.41 an hour
- 8 hour shift
- Hybrid work
- Microsoft Word
- Nursing
- Microsoft Excel
8d
Care Review Clinician (RN) - Remote in FL
Molina Healthcare —Tampa, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Utilization Review Specialist Senior
BayCare —Tampa, FL
- Weekends as needed
- Hybrid work
- Nursing
- RN License
- Hospital
- Tuition reimbursement
- 401(k) matching
CLINICAL DOCUMENTATION SPECIALIST II
Moffitt Cancer Center —Tampa, FL
- $82,934.80 - $126,427.60 a year
- Full-time
- Nursing
- RN License
- Writing skills
Clinical Navigator
Paradigm Corp —Tampa, FL
- $73,000 - $88,000 a year
- Full-time
- Remote
- Spanish
- RN License
- Customer service
- Health savings account
- Paid holidays
6d
Senior Consultant - Clinical Documentation Specialist
Deloitte —Tampa, FL
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Denials Management Appeals Nurse (Anesthesia)
Shriners Hospitals for Children —Tampa, FL
- $80,912.00 - $121,388.80 a year
- Full-time
- 18 years or older
- Nursing
- RN License
Quick Apply
RN Nurse Reviewer
CSTS Customer Service and Technology Solutions LLC —Tampa, FL
- $74,000 a year
- Weekends as needed
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Supervisor of Case Management
Moffitt Cancer Center —Tampa, FL
- $85,009.60 - $129,584.00 a year
- Full-time
- Hybrid work
- Acute care
- Nursing
- RN License
12d
Nurse Manager RN Center for Endoscopy
AdventHealth Tampa —Tampa, FL
- $77,758.69 - $144,624.32 a year
- Weekends as needed
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
Case Manager RN PRN
HCA Florida Largo Hospital —Largo, FL
- PRN
- Surgery
- Mid-level
- 3 years
- Employee stock purchase plan
- Disability insurance
Quick Apply
Utilization Reviewer 2
Enlyte —Tampa, FL
- $59,500 - $76,000 a year
- Full-time
- RN License
- Mid-level
- Office
- Health savings account
- AD&D insurance
Medical Case Manager I
CorVel Corporation —Tampa, FL
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Complex Case Manager (RN or LPN)
TGH Senior Center Powered by Greenbrook Medical —Tampa, FL
- $100,000 a year
- Spanish
- Nursing
- Skilled nursing facility
- Dental insurance
- Paid time off
Complex Case Manager (RN or LPN)
Greenbrook Medical —Tampa, FL
- $100,000 a year
- Spanish
- Nursing
- Skilled nursing facility
- Dental insurance
- Paid time off
Registered Nurse Medical Surgical
AdventHealth Riverview —Riverview, FL
- $31.53 - $52.24 an hour
- Full-time
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
RN Case Manager PRN Days
Moffitt Cancer Center —Tampa, FL
- $44.25 an hour
- Weekends as needed
- Nursing
- RN License
- BLS Certification
10d
CAREGIVER SUPPORT PROGRAM REGISTERED NURSE
US Veterans Health Administration —Bay Pines, FL
- $75,987 - $148,013 a year
- Temporary
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
9d
Case Manager, Value Based
Tampa Family Health Centers —Tampa, FL
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Paid holidays
- Disability insurance
Quick Apply
4d
RN Care Manager - FGC Market
ArchWell Health —Tampa, FL
- Full-time
- Nursing
- RN License
- Mid-level

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Case Manager, RN- Utilization Review

Tampa General Hospital -
Tampa, FL

Apply Now

Job Details

Full-time
$36.41 an hour
8 days ago

Qualifications

RN License

Full Job Description

Description

Under the general supervision of the Utilization Management Manager and in accordance with established policies, professional guidelines, and CMS Conditions of Participation for Utilization Review, the Utilization Management Nurse (UMN) ensures patients are assigned to the most appropriate level of care based on nationally recognized admission and continued stay criteria. The UMN performs admission, concurrent, and retrospective utilization reviews using clinical expertise and medical necessity screening tools; evaluates appropriateness of services and expected length of stay; and supports timely authorization determinations through collaboration with payers. The UMN works closely with physicians, Care Coordinators, Resource Center Associates, Nursing, and leadership to address cases where criteria are not met, escalate concerns to the Physician Advisor or appropriate medical leadership, participate in denial management, and support efficient patient flow. All duties are performed in alignment with Tampa General Hospital’s mission, vision, values, and quality standards.

Technical Knowledge, Skills, and Abilities

In‑depth knowledge of utilization review processes, nationally recognized medical necessity criteria (e.g., InterQual or similar), and appropriate level‑of‑care determination.
Ability to apply clinical nursing knowledge to evaluate the appropriateness of admissions, continued stays, diagnostic testing, and treatment plans.
Knowledge of Medicare, Medicaid, managed care, and commercial payer requirements, including authorization, denial, and appeal processes.
Ability to identify cases where criteria are not met, analyze complex clinical and payer‑specific issues, and escalate appropriately through physician, Physician Advisor, and leadership channels.
Strong communication skills with the ability to effectively collaborate with physicians, payers, interdisciplinary teams, and leadership to justify medical necessity, resolve denials, and support patient flow.
Proficiency in accurate, timely documentation of utilization reviews, payer communications, and determinations using electronic medical records and utilization management systems.

Essential Functions

Conducts initial admission reviews using nationally accepted criteria to determine medical necessity, appropriate level of care, and patient status designation.
Performs concurrent and ongoing reviews to assess continued stay, appropriateness of services, and expected length of stay, ensuring alignment with clinical presentation and regulatory requirements.
Reviews retrospective cases and participates in denial management, including preparation of clinical documentation and support for appeals in collaboration with Physician Advisors and Appeals teams, when appropriate.
Collaborates with payers regarding medical necessity determinations, authorization decisions, and continued stay reviews for inpatient admissions and clinical services.
Identifies cases where admission or continued stay criteria are not met and communicates findings with the attending physician, escalating to the Physician Advisor or appropriate medical leadership as needed.
Works closely with Care Coordinators, Resource Center Associates, Nursing, Physicians, and leadership to support appropriate patient status, care progression, and effective utilization of hospital resources.
Promotes appropriate status designation and medical necessity decisions to support timely patient movement and efficient hospital throughput.
Documents all utilization reviews, payer interactions, authorization decisions, clinical findings, and determinations in accordance with departmental standards, regulatory requirements, and organizational policies.
Contributes to departmental and organizational performance improvement initiatives related to utilization management, denial reduction, regulatory compliance, and quality outcomes.
Performs all duties in accordance with CMS Conditions of Participation, hospital utilization review plans, confidentiality standards, and professional nursing and utilization management guidelines.
Proficiency in Microsoft applications, including Outlook, Teams, Word, and Excel, to support clinical documentation, communication, data tracking, reporting, and interdisciplinary collaboration in a remote or hybrid work environment.

Qualifications

Licensed as a Registered Nurse in the state of Florida
Three (3) years as a practicing RN.
Utilization Management experience preferred

Primary Location: Tampa

Work Locations: TGH Main Campus 1 Tampa General Circle Tampa 33601

Eligible for Remote Work: Fully Remote

Job: Case Management

Organization: Florida Health Sciences Center Tampa General Hospital

Schedule: Full-time

Scheduled Days: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday

Shift: Day Job

Job Type: Remote

Shift Hours: 8-1630

Minimum Salary: 36.41

Job Posting: Aug 14, 2026, 1:17:05 PM

Apply Now

Refine Your Search

utilization review rn jobs in tampa fl

Case Manager, RN- Utilization Review

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Complex Case Manager (RN or LPN)

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I want to receive the latest job alert for utilization review rn in tampa fl

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