Oct 13, 2021

Utilization Review Specialist Senior

  • BayCare Health System
  • Florida, USA

Job Description

Utilization Review Specialist Senior(

Job Number:



BayCare is a leading not-for-profit health care system that connects individuals and families to a wide range of services at 15 hospitals and hundreds of other convenient locations throughout the Tampa Bay and central Florida regions. BayCare is proud to be recognized as a 2020 Fortune “100 Companies to Work For” and 2020 Best Workplaces in Healthcare and Biopharma.

Winter Haven Hospital is a 527 bed hospital located in Winter Haven, FL. Founded in 1926, Winter Haven Hospital has an outstanding reputation for superior, patient-centered care. Our mission statement is "to improve the health of the people we serve, by providing the highest quality and most effective care and services -- and to return value to the people in our communities." By upholding this standard of excellence in all that we do, we are able to provide patients throughout central Florida with customized, state-of-the-art treatments in a comfortable environment.

Benefit eligible positions at BayCare offer a competitive total reward package including benefits, paid time off, tuition reimbursement, 401k match and additional yearly contribution, yearly performance appraisals and team award bonus, community discounts and the chance to be part of an amazing team and a great place to work!

The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. Preferred experience includes Critical Care or Emergency Nursing RN.


Certifications and Licensures
RequiredRN (Registered Nurse)
PreferredACM (Case Management)
PreferredCCM (Case Manager)


Required2 yearsUtilization Review
Or2 yearsCase Management
Or4 yearsRegistered Nurse
PreferredReference summary for details

Specific Skills
RequiredCustomer service skills
RequiredWritten and verbal communication skills
RequiredInterpersonal skills
RequiredWork with a team
RequiredCritical thinking skills
RequiredKnowledge of regulatory standards appropriate to position
RequiredWork independently
RequiredDelegation skills
RequiredComputer skills appropriate to position
RequiredOrganizational skills



Primary Location

: FL-Winter Haven-Winter Haven Hospital, Inc
Schedule: Varies


: Days
Shift Hours: 8:00 AM - 4:30 PM
Weekend Work: Occasional
On Call: No
Employment Status: ACTIVE FULL TIME

Equal Opportunity Employer Veterans/Disabled