Description 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. Essential Functions 1. Admissions Reviews 2. Concurrent Reviews 3. Case Escalations for appropriate status 4. Concurrent Denials Management 5. Interdisciplinary discussions and Provider partnerships Qualifications Education Associate's Degree- Nursing License/Registration Registered Nurse- Issued by Florida or Compact State Work Experience and Additional Information Three (3) years as a practicing RN in an acute care setting and least two (2) years' experience as a case manager HMO/Managed Care/Medicare/Medicaid experience

Primary Location :

Crystal River Work Locations :

TGH Crystal River 6201 N Suncoast Boulevard Crystal River 34428 Eligible for

Remote Work:

On Site Job :

Case Management Organization :

Tampa General Hospital-Citrus Shift :

Day Job Job Type :

On Site Shift Hours:

8-4:30

PM Minimum Salary :

47.00

Job Posting :

Sep 15, 2026, 11:56:46 AM