Pool Case Manager Utilization Review - (260003NE)
The Utilization Review Case Manager validates the patient’s placement to be at the most appropriate level of care based on nationally accepted admission criteria. Team member uses medical necessity screening tools, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient’s expected length of stay. The Utilization Review Case Manager secures authorization for the patient’s clinical services through timely collaboration and communication with payers as required. The Utilization Review Case Manager follows the process as defined in the Utilization Review Plan in accordance with the TGH Conditions of Participation for Utilization Review.Essential Functions
EducationAssociate's Degree- Nursing
License/RegistrationRegistered Nurse- Issued by Florida or Compact StateWork Experience and Additional InformationThree (3) years as a practicing RN in an acute care setting and least two (2) years’ experience as a case managerHMO/Managed Care/Medicare/Medicaid experience
: Crystal River
TGH Crystal River
6201 N Suncoast Boulevard
Crystal River 34428
Eligible for Remote Work: On Site
: Case Management
: Tampa General Hospital-Citrus
: Day Job
: On Site
Shift Hours: 8-4:30PM
: 47.00
: Sep 15, 2026, 4:56:46 PM
Tampa General is a private not-for-profit hospital and one of the most comprehensive medical facilities in West Central Florida serving a dozen counties with a population in excess of 4 million. As one of the largest hospitals in Florida, Tampa General is licensed for 982 beds, and with over 15,000 team members, is one of the region’s largest employers.
Consistently recognized for world-class care, Tampa General Hospital is ranked as the #1 hospital in Tampa Bay by U.S. News & World Report for 2024-25 and is nationally ranked as among the top 50 hospitals in the nation in eight specialties. Additionally, Tampa General was ranked as “high performing,” or among the top 10% of hospitals in the nation, in five more specialties along with 12 procedures and conditions.
TGH partners with the USF Health Morsani College of Medicine to pioneer breakthrough treatments, conduct game-changing clinical research and train the next generation of health care professionals. TGH is the region's only academic health system, having been affiliated with the USF Health Morsani College of Medicine since the school was created in the early 1970s.
TGH is the area’s only Level I trauma center and one of two ABA-verified Adult & Pediatric burn centers in Florida. With five medical helicopters, we are able to transport critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. The hospital is home to the leading organ transplant center in the country, having performed more than 14,000 adult solid organ transplants, including the state’s first successful heart transplant in 1985. Tampa General Hospital is committed to serving all residents of West Central Florida. We provide comprehensive health services, ranging from wellness and primary care to the most complex specialty care and post-acute services.
