ZipRecruiter

Log In

1

Utilization Review Case Management Rn Jobs in Florida

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Accredited Case Manager - Registered Nurse (ACM-RN) preferred. * Certified Case Manager (CCM ...

American Traveler

Travel RN Case Management

Largo, FL · On-site

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Acrisure

Utilization Review Nurse

Bradenton, FL

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

GQR Healthcare

Travel Utilization Review RN

Fort Myers, FL · On-site

$1.7K - $1.8K/wk

GQR Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

next page

Showing results 1-20

All JobsUtilization Review Case Management Rn JobsUtilization Review Case Management Rn Jobs in Florida

Utilization Review Case Management Rn information

What cities in Florida are hiring for Utilization Review Case Management Rn jobs?

Cities in Florida with the most Utilization Review Case Management Rn job openings:

Infographic showing various Utilization Review Case Management Rn job openings in Florida as of June 2026, with employment types broken down into 3% As Needed, 65% Full Time, 26% Part Time, and 6% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution.

Case Manager, RN- Utilization Review

Tampa, FL • On-site

Tampa General Hospital
Hospitals • 5 - 10K employees
Learn more about Tampa General Hospitalexternal

Full-time

Re-posted 7 days ago

Tampa General Hospital rating

7.4

Company rating: 7.4 out of 10

Based on 163 frontline employees who took The Breakroom Quiz

Job description

A Brief Overview
The Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. Team member uses medical necessity screening tools, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay. The Utilization Review Case Manager secures authorization for the patient's clinical services through timely collaboration and communication with payers as required. The Utilization Review Case Manager follows the process as defined in the Utilization Review Plan in accordance with the TGH Conditions of Participation for Utilization Review.
What you will do

  • Admissions Reviews
  • Concurrent Reviews
  • Case Escalations for appropriate status
  • Concurrent Denials Management
  • Interdisciplinary discussions and Provider partnerships

Education Qualifications

  • Associate's Degree Nursing

Licenses and Certifications

  • Registered Nurse

Experience Qualifications

  • Three (3) years as a practicing RN in an acute care setting and least two (2) years' experience as a case managerHMO/Managed Care/Medicare/Medicaid experience

Skills and Abilities

  • Monitor and manage all inpatient hospital admissions with the goal of achieving cost- effective patient care.
  • Identifies when those situations where criteria is not met for admission and discuss issues with the attending physician
  • Utilize clinical skills, chart review, physician communication and clinical screening tool and utilize peer review as necessary.
  • Identify when those situations where criteria is not met for admission and discuss issues with the attending physician, refer all appropriate cases to the ACMO or Physician Advisory Service.
  • Follow established policies, procedures and professional guidelines while working closely with Resource Center Associates, Care Coordinators, Nursing and Providers to obtain clinical information to justify proposed services and care; establish strong relationships with Managed Care Organizations to enhance the ability to obtain authorizations for services
  • Liaises with the manager and reports all situations requiring management intervention
  • Will perform job functions in accordance with mission, vision and values of Tampa General Hospital.

What Tampa General Hospital employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Tampa General Hospital logo

About Tampa General Hospital

Sourced by ZipRecruiter

Tampa General Hospital was named the #1 hospital in Tampa Bay by U.S. News & World Report, 2020-2021, and recognized as one of America's Best Hospital's in five medical specialties: Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Nephrology, and Orthopedics. Tampa General Hospital has been designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC), the highest recognition for nursing excellence, for the fourth consecutive time - an accomplishment that fewer than one percent of hospitals nationwide have earned. TGH is accredited by The Joint Commission and was awarded disease-specific certification in five medical specialties. TGH is also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). *Air transport provided by Metro Aviation, Inc.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Tampa, FL, US

Year founded

1927

View All Tampa General Hospital Jobs

Apply