Hiring: Manager, Utilization Review Company: Tampa General Hospital Location: Tampa, FL Job Posted Time: 2026-09-10 11:37:50 Employment Type: Full-time / Remote Target Skills & Keywords : Care Coordination, Revenue Cycle Management, Risk Management, Utilization Review About the job Required Skills: •Monitors, reports outcomes/patterns/trends; guides/supports Team Lead. •Assists Director with reporting and case presentations. Participates in mtgs per Director. •Identifies opportunities for UM Strategic planning. •Leads and participates in departmental and organizational performance improvement activities including the utilization of variance and denial data to assist hospital leadership in identifying opportunities for improvement. •Assesses the quality of work performed in the department, providing feedback to employees with the goal of continuous improvement. •Serves as a resource to staff to support, manage, and/or resolve issues related to utilization/denials management, and hospital admission authorization. •Completes necessary research to gather appropriate details/information prior to making decisions when complex issues are presented. •Submits staff performance management report, maintaining productivity at approved standards. Qualifications: •Bachelor’s Degree Nursing •Five (5) years of clinical experience and a minimum of five (5) years experience in utilization management and/or case management required and may substitute for the degree. •Develops the procedures required for an efficient, effective utilization review program, to successfully manage the implementation of that program and concomitant activities of the Utilization Review Nurses and Case Management Extenders in a fast paced, dynamic environment. •Maintains current knowledge of all local, state, and federal regulatory requirements related to care coordination responsibilities. •Has an in-depth understanding of utilization management guidelines used to evaluate patient care and status. •Develops effective processes to ensure accurate and timely admission and continued stay reviews, appropriate authorizations for care and quality communication with payers and caregivers. Positive impact on revenue is demonstrated by the successful fulfillment of these duties. •Quality/Utilization Management •Florida Health Sciences Center Tampa General Hospital Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!