RN-Utilization Review/ Denials and Appeal Coordinator

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer.

As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces.

Summary

Works with Case Management leadership to establish quality review standards for discharge planning documentation, utilization review, and the applications of clinical criteria (InterQual). Maintains knowledge of regulatory, appeal, and survey standards. Responsible for overseeing the Case management workflow of concurrent denials for government and managed care appeals. Assures all deadlines are met. Works closely with the Physician Advisor and Case Management leadership as needed. As needed, provide guidance, orientation, and training to Case Management staff regarding hospital policy, regulatory standards, and utilization review criteria. Responsible for keeping staff current on governmental mandates and changes.

Job Title: Utilization Review Denials and Appeals Coordinator

Minimum Education Level: Bachelor's Degree

Minimum Field Of Study

Minimum Education Notes:

Preferred Education Level: Master's Degree

Preferred Field of Study: Nursing or Healthcare Administration

Preferred Education Notes

Licensure Certification Needed: Yes

Minimum Licensure: Registered Nurse (RN)

Minimum Licensure (Other)

Graduate of an accredited school of nursing required.

Current Florida RN Licensure Required.

Minimum 5 years clinical experience in an acute care setting required.

Minimum 1 year case management/utilization review/denial and appeal experience in an acute care setting required.

Must be able to work independently with minimal direction, anticipate and organize workflow, prioritize and follow

Through On Responsibilities

Training Required:

Preferred Licensure: Basic Life Support (BLS)Other (If other, please enter details in section to the right)Other (If other, please enter details in section to the right)

Preferred Licensure (Other): CCMACM

Salary Range

$85,009.60 - $129,584.00

Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions.

We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce.

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• Equal Employment Opportunity
  
  

Moffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.

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