Denials Specialist RN - Utilization Review
Tampa, FL · HybridFull-timeSeen 1w agoSeen in employer's feed 5 days ago
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At a glance
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Requirements
Credentials this posting asks for.
Job overview
BayCare Health System seeks a Denials Specialist RN for utilization review. The role reviews denied or potentially medically unnecessary inpatient and outpatient claims, coordinates appeals or billing-status corrections, and identifies trends in adverse determinations. It works closely with physician advisors and teams across registration, business office, authorization, and coding. The position is hybrid in Tampa/St. Petersburg and is full-time, 40 hours per week.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
The Denials Specialist-Utilization Review responsibilities include:
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Timely reviews of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity.
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Works closely with the Physician Advisors, Registration, Central Business Office (CBO), Central Authorization Unit(CAU), and Coding department team members.
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Maintains and coordinates a timely appeal process or effectuates a correction of billing status.
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Identifies and trends adverse determinations, and shares information with all stakeholders. Performs other duties as assigned by department leadership.
Position details:
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Location: Hybrid - Tampa/St Petersburg
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Status: Full time, 40 hours per week. Exempt
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Schedule: Monday - Friday 7:00 AM - 3:30 PM(can be flexible)
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Weekend Requirement: Occasional
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On Call: No
Certifications and Licensure:
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Required RN License
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Preferred Accredited Case Manager Certification
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Preferred Certified Case Manager
Education and Experience:
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Required 4 years RN experience with ASN and 2 years RN experience with BSN
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Required 2 years Utilization Review OR Care Coordination/Case Management OR Managed Care OR Finance experience
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Preferred Masters Degree in Nursing
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Preferred 6 months Denials Management
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Preferred 1 year Medicaid/Medicare experience
Benefits:
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Benefits (Health, Dental, Vision)
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Paid time off
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Tuition reimbursement
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401k match and additional yearly contribution
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Yearly performance appraisals and team award bonus
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Community discounts and more
Equal Opportunity Employer Veterans/Disabled
Position Denials Specialist RN - Utilization Review
Location Tampa:St Josephs | Clinical | Full Time
Req ID 180585
How this job compares
Set against the 28,941 open Nurse jobs on Olive Jobs, counted November 12, 2026.
- Pay
- This postingNot listed
- Florida median$71–110K/yr156 salary ranges
- Florida median$32–52/hr797 hourly ranges
- Openings
- Olive Jobs lists 1,952 open Nurse jobs in Florida and 28,941 across the US. Under 1% of them nationwide are listed as remote or flexible.
- Hiring the most in Florida
- AdventHealth491 open
- HCA Healthcare438 open
- Aveanna Healthcare154 open
- Experience
- This posting asks for at least 2 years of experience; Nurse postings that state a minimum ask for 1 year at the median (12,083 postings).
- Education
- 3,184 of the 28,941 open Nurse jobs (11%) ask for a bachelor's degree or higher.
Pay, requirements and demand for Nurse jobs
Counted across the open, public US postings on Olive Jobs on November 12, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.
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