$85,009.60 - $129,584 / year
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. Moffitt Career Site If you have the vision, passion, and dedication to contribute to our mission, then we have a place for you! 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. Reasonable Accommodation Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Moffitt endeavors to make moffitt.org/careers accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact one of the Human Resources receptionists by phone at 813-745-7899 or by email at HRReceptionists@moffitt.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. Read more information about your EEO rights under the law. Transparency in Coverage Rule 
