SECUR Health Plan·Tampa, Florida
The Utilization Review Nurse performs care management duties to assess, plan, and coordinate medical services across the continuum of care. They are responsible for conducting authorization reviews, discharge planning, and facilitating communication between patients, providers, and medical management systems.
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Role: The Utilization Review Nurse performs care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Bachelor’s degree in nursing or related field or an equivalent combination of work experience and education Current license as RN or LPN, current active single-state out-of-state nurse license, or current active multistate/compact nurse license Minimum 2 years of clinical nursing experience in a managed care, clinical, acute care, or community setting CCM or other case management certification preferred Demonstrated knowledge of payor contracts and able to provide clinical information to Physicians to ensure cost effective care and metrics standards Previous experience working with an EMR/EHR (Electronic Medical/Health Record) system Proficient Microsoft Office Suite skills Ability to convey empathy and compassion in emotionally charged situations Ability to effectively communicate in English (verbal and written) Job Responsibilities: Perform standard, retrospective, and/or concurrent reviews of authorization requests submitted by in-network and out-of-network providers Perform discharge planning assessment and coordination of subacute care services and benefit enhancements Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options; coordinate and conduct utilization management activities Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff to meet the complete medical socio-economic needs of clients; enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Provide education to patients and providers Facilitate member access to community-based services Provide relevant data for Utilization Management Committee Meetings, attend and participate as required Identify related risk management quality concerns and reports these scenarios to the appropriate resources Performs other duties as assigned Compensation Pay Range: $73,915.89 - $110,874.35 This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.
Candidates must hold a Bachelor’s degree in nursing or a related field and possess a current active nursing license. A minimum of 2 years of clinical nursing experience in a managed care or acute care setting is required, along with proficiency in EMR systems and Microsoft Office.
Market context
In Florida, nursing roles are typically in steady demand across hospice, hospital, and other care settings, especially for RNs who can work independently and adapt to varied patient needs. These positions are competitive because employers often look for current RN licensure, at least one year of experience, active BLS certification, and reliable transportation, while benefits commonly include health insurance, professional development, and a supportive work environment. Before applying, confirm your license, BLS status, and driving readiness, and review the AI-summarized requirements and benefits here to save time versus reading the full original posting.