Utilization Management Director jobs in Tampa, FL

Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)

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Remote Utilization Management RN
  • AdventHealth Tampa
  • Tampa, FL FULL_TIME
  • Description


    All the benefits and perks you need for you and your family:

    • Student Loan Repayment Program
    • Career Development
    • Whole Person Wellbeing Resources
    • Nursing Clinical Ladder Program*
    • Sign-on Bonus*
    • Relocation Bonus*
    • Team Based Nursing Model*
    • Reimbursement for the NCLEX*
    • Nursing or BU specific benefits and perks

    Our promise to you:

    Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

    Schedule: Full Time, Days

    Location: 3100 East Fletcher Avenue Tampa, Florida 33613

    The community you’ll be caring for: AdventHealth Tampa

    • AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
    • Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
    • Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
    • Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.

    The role you’ll contribute:

    The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine legitimacy of hospital admission, treatment, and appropriate level of care. The UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations. The UM RN is responsible to document findings based on department and regulatory standards. When screening criteria does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM RN is responsible for denial avoidance strategies including concurrent payer communications to resolve status disputes.

    The value you’ll bring to the team

    • Facilitating precertification and payor authorization processes as required, ensuring proper authorization has been secured prior to or at the time of discharge for observation and inpatient stay visits to avoid unnecessary denials.
    • Working in collaboration with facility Care Management to ensure that high quality health care services are provided in a cost-efficient and compliant manner, in line with regulatory standards.
    • Adhering to all rules and regulations of applicable local, state, and federal agencies and accrediting bodies.
    • Actively participating in team workflows and accepting responsibility in maintaining relationships.
    • Monitors admissions and performs initial patient reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis.
    Qualifications


    The expertise and experiences you’ll need to succeed:

    Minimum qualifications:

    • Current Florida RN License
    • Graduate of an accredited school of nursing
    • Associates in Nursing
    • 3 years of acute care hospital experience
    • Demonstrate knowledge and skills necessary to provide appropriate status recommendations based on medical necessity indicators, findings, and documentation.
    • BLS

    Preferred qualifications:

    • Bachelor’s Degree in Nursing
    • Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
    • Thorough knowledge of medical admission screening requirements to assist in determining appropriateness of admission, treatment requested, for a variety of conditions, per evidence-based guidelines.
    • Knowledge of hospital reimbursement models and trends and their impact to AdventHealth.
    • Previous experience with and working knowledge of medical necessity screening tool.
    • Strong analytical and problem solves skills.
    • Minimum four years Utilization Management within acute care setting
    • Experience working in electronic health records of at least two years
    • ACM/CCM

    This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
  • 24 Days Ago

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Utilization Management RN
  • AdventHealth Tampa
  • Tampa, FL FULL_TIME
  • Description All the benefits and perks you need for you and your family: Sign-on Bonus up to $35,000 & Relocation Bonus up to $10,000 Benefits & Paid Days Off from Day One Student Loan Repayment Progr...
  • Just Posted

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Utilization Management Nurse
  • ReqRoute,Inc
  • Tampa, FL FULL_TIME
  • Role: Utilization Management Nurse Location: Remote/ Work from Home Term: Contract Ideal candidates will have a few years of Major payor experience, experience working with a 3rd party vendor, Telecom...
  • 6 Days Ago

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Utilization Management Specialist Non Clinical
  • AdventHealth Tampa
  • Tampa, FL FULL_TIME
  • Description All the benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Student Loan Repayment Program Career Development Our promise to you: Joining ...
  • 8 Days Ago

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Utilization Management Rep I (contract)
  • Elevance Health
  • Tampa, FL FULL_TIME
  • Job ID:43542 Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused ...
  • 11 Days Ago

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RN - Case Managers, Disease Managers & Utilization Management
  • ERP International
  • Dill, FL OTHER
  • Overview ERP International is seeking Registered Nurses (RN) for Full-Time positions in Case Management, Disease Management, and Utilization Management at MacDill AFB, FL. Apply online today and disco...
  • 21 Days Ago

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0 Utilization Management Director jobs found in Tampa, FL area

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Sr. Manager/Director of Facilities Maintenance (REH)
  • The Judge Group
  • Tampa, FL
  • As a result of rapid growth and expansion, our client has retained us to fill a highly visible Confidential Director of ...
  • 3/28/2024 12:00:00 AM

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Sr. Manager/Director, Industrial Engineering/Operational Excellence (REH)
  • The Judge Group
  • Tampa, FL
  • As a result of rapid growth and expansion, our client has retained us to fill a highly visible Confidential Director Ope...
  • 3/28/2024 12:00:00 AM

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Assistant Nurse Manager Nights
  • Adventhealth Wesley Chapel
  • Wesley Chapel, FL
  • Job Description All the benefits and perks you need for you and your family: n nn n Paid Days Off from Day One n n Stude...
  • 3/28/2024 12:00:00 AM

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Assistant Nurse Manager Nights
  • Adventhealth
  • Wesley Chapel, FL
  • All the benefits and perks you need for you and your family: · Paid Days Off from Day One · Student Loan Repayment Progr...
  • 3/25/2024 12:00:00 AM

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Insurance Representative
  • Transamerica Premier Life Insurance Company
  • Tampa, FL
  • The Insurance Representative is directly responsible for writing new quality business, conserving existing business, pro...
  • 3/25/2024 12:00:00 AM

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Vice President / Audit Manager - IA Finance COO and Change (Hybrid)
  • Citigroup, Inc.
  • Tampa, FL
  • The Audit Manager is an intermediate level role responsible for managing a team that is performing complex and critical ...
  • 3/25/2024 12:00:00 AM

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A Youth Development Program Director (Starkey) - Pinellas/Pasco School Age Programs
  • YMCA of the Suncoast
  • Clearwater, FL
  • Title: Youth Development Program Director - Starkey Reports to: Youth Development Program Management Director FLSA Statu...
  • 3/25/2024 12:00:00 AM

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Director of BESS Engineering | DC (open to remote) | Utility & DG BESS
  • Viridan Group
  • Tampa, FL
  • Director of BESS Engineering | DC (open to remote) | Utility & DG BESS Are you a Snr Engineer in the energy storage spac...
  • 3/24/2024 12:00:00 AM

Tampa is a major city in, and the county seat of, Hillsborough County, Florida, United States. It is on the west coast of Florida on Tampa Bay, near the Gulf of Mexico, and is the largest city in the Tampa Bay Area. The bay's port is the largest in the state, near downtown's Channel District. Bayshore Boulevard runs along the bay, and is east of the historic Hyde Park neighborhood. Today, Tampa is part of the metropolitan area most commonly referred to as the "Tampa Bay Area". For U.S. Census purposes, Tampa is part of the Tampa-St. Petersburg-Clearwater, Florida Metropolitan Statistical Area....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Management Director jobs
$120,203 to $162,536
Tampa, Florida area prices
were up 1.1% from a year ago

Utilization Management Director in Johnstown, PA
Prior authorization decisions are also made using Medical Management and Behavioral Health Care Management internally derived policies and procedures developed using evidence-based guidelines based on national, state and locally established standards of practice.
March 01, 2020
Utilization Management Director in Carson City, NV
The utilization management coordinator must have strong project management skills to implement various programs within the allocated budget and set time limits.
January 31, 2020
Utilization Management Director in Melbourne, FL
Develops and administers polices and procedures for utilization control of inpatient and outside referral services countywide and for in a variety of categorical programs including the Medically Indigent Adult (MIA) Program.
January 08, 2020