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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 ...

Acadia Healthcare

Utilization Specialist

North Port, FL · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist

North Port, FL · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist

Fort Myers, FL · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist

Fort Myers, FL · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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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.
More about Anthem Utilization Review Nurse jobs
What are the most commonly searched types of Anthem Utilization Review Nurse jobs in Florida? The most popular types of Anthem Utilization Review Nurse jobs in Florida are:
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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.
Nurse Case Manager

Nurse Case Manager

Halifax Health

Daytona Beach, FL • On-site

Full-time

Posted 2 days ago

Halifax Health rating

6.0

Company rating: 6.0 out of 10

Based on 65 frontline employees who took The Breakroom Quiz

726th of 864 rated healthcare providers

Job description

Day (United States of America)
Nurse Case Manager
The purpose of the Nurse Case Manager is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement in needed (e.g., day to day workflow, education, process improvements, patient satisfaction).
  • Completion of an accredited LPN or RN nursing program
  • 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 communication skills
  • Demonstrates flexibility via an ability to adapt to changing priorities
  • Demonstrates good customer relations
  • Ability to prioritize assignments and effective time-management skills
  • Basic knowledge of clinical and psychosocial aspects of patient care
  • Must be detail oriented, flexible, and committed to patient advocacy
  • Demonstrates skills in planning, organizing, and managing multiple functions and complex processes
  • Excellent verbal and written communication skills required
  • Knowledge of basic computer software programs
  • Knowledge of area community resources and referrals

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