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Anthem Utilization Review Nurse Jobs in Florida (NOW HIRING)

Halifax Health

Nurse Case Manager

Daytona Beach, FL · On-site

Three years acute care experience in a hospital setting; one year as a utilization review nurse preferred * Licensed Nurse in the State of Florida * Demonstrates effective interpersonal and ...

Halifax Health

Nurse Case Manager

Daytona Beach, FL · On-site

Three years acute care experience in a hospital setting; one year as a utilization review nurse preferred * Licensed Nurse in the State of Florida * Demonstrates effective interpersonal and ...

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$15

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$51

How much do anthem utilization review nurse jobs pay per hour?

As of May 28, 2026, the average hourly pay for anthem utilization review nurse in Florida is $31.60, according to ZipRecruiter salary data. Most workers in this role earn between $24.95 and $36.30 per hour, depending on experience, location, and employer.

What is an Anthem Utilization Review Nurse job?

An Anthem Utilization Review Nurse evaluates medical services and treatments to ensure they meet established guidelines for medical necessity, cost-effectiveness, and quality care. They review patient records, collaborate with healthcare providers, and determine appropriate levels of care based on insurance policies. This role helps manage healthcare costs while ensuring patients receive necessary treatments. Utilization review nurses typically work remotely or in clinical settings and must have a nursing background with expertise in case management and insurance regulations.

What are the key skills and qualifications needed to thrive in the Anthem Utilization Review Nurse position, and why are they important?

To thrive as an Anthem Utilization Review Nurse, you need an active RN license, clinical care experience, and strong knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, InterQual or Milliman guidelines, and proficiency in electronic medical records are commonly required. Attention to detail, critical thinking, and excellent written and verbal communication distinguish top performers in this position. These skills ensure thorough and accurate case reviews, support compliance with policy, and facilitate effective communication between healthcare providers, insurers, and patients.

What does a typical day look like for an Anthem Utilization Review Nurse?

A typical day for an Anthem Utilization Review Nurse involves reviewing patient medical records to determine the medical necessity of services, coordinating with healthcare providers via phone or email, and documenting determinations in electronic systems. Nurses in this role often attend team meetings, consult with physicians, and may help educate providers on clinical guidelines and coverage policies. The work is mostly desk-based and may be remote or office-based, depending on Anthem's structure. This position requires balancing productivity targets with careful case analysis, and it offers a predictable schedule with limited direct patient interaction, making it ideal for nurses seeking to apply their expertise in a non-clinical setting.
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Anthem Utilization Review Nurse jobs near you
Infographic showing various Anthem Utilization Review Nurse job openings in Florida as of May 2026, with employment types broken down into 9% As Needed, 72% Full Time, and 19% Contract. Highlights an 82% In-person, and 18% Remote job distribution, with an average salary of $65,722 per year, or $31.6 per hour.
Utilization Management Professional,

Utilization Management Professional,

Integrated Resources INC

Miami, FL

Full-time

Posted 10 hours ago

Job description

Company Description

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Job Description


  • Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services.
  • Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information.
  • Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity.
  • Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.

Caseload: 25-30 reviews per day. This position is 98% telephonic.

Qualifications

The candidate will work an 8 hour shift that could start between the hours of 8am - 10:30am.

Requirements/Certifications:

  • THIS IS A TEMP-TO-PERM POSITION.
  • Caseload: 25-30 reviews per day. The majority of the caseload is via fax.
  • The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp.
  • A strong candidate would be familiar with MCG and Interqual.
  • License and Educational requirement: LPN - Licensed Practical Nurse.
  • An Associate's Degree is required for the LPN and the RN - Registered Nurse - A Bachelor's Degree is required for the RN
Additional Information

All your information will be kept confidential according to EEO guidelines.

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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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