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Authorization Utilization Review Jobs in Florida

UF Health

RN, Utilization Management

Saint Johns, FL · On-site

Requires clear communication of authorization decisions and ongoing monitoring to support timely ... Registered Nurse (RN) license with 3+ years experience in utilization review or case management ...

Memorial Healthcare

Serves as liaison to insurance companies for prior authorizations and removes barriers to discharge ... Utilization Review Committees:Co-leads hospital specific UR Committee and is a member of the system ...

Guardian Recovery

UR COORDINATOR

Delray Beach, FL · On-site

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of ... Manage and perform the processes for retrospective authorizations and denials/appeals. * Timely ...

Uloop Inc.

Medical Management Coordinator, RN

Miami, FL · On-site

$60 - $90/hr

Qualifications Minimum 2 years of experience with pre-authorization, utilization review/management, case management, care coordination, and/or discharge planning. Knowledge/Skills/Abilities ...

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Authorization Utilization Review information

What is authorization utilization review?

Authorization Utilization Review is a process used by healthcare organizations and insurance companies to assess the medical necessity and appropriateness of medical services before they are provided. The main goal is to ensure that patients receive care that is effective, efficient, and covered by their health plan. This review typically involves evaluating patient records, treatment plans, and provider requests to decide if the requested services meet established guidelines. By doing so, it helps control healthcare costs and ensures quality care for patients.

What are the key skills and qualifications needed to thrive as an authorization utilization review specialist?

To thrive as an Authorization Utilization Review Specialist, you need a solid understanding of medical terminology, healthcare regulations, and insurance policies, often backed by a clinical background or relevant certifications. Familiarity with utilization management software, electronic health records (EHR), and payer portals is typically required. Strong attention to detail, analytical thinking, and effective communication are vital soft skills for coordinating with providers and payers. These skills ensure accurate authorization decisions, regulatory compliance, and efficient patient care coordination.

What are some common challenges faced by professionals in authorization utilization review roles, and how can they be addressed?

Professionals in Authorization Utilization Review often encounter challenges such as managing high caseloads, navigating complex insurance guidelines, and ensuring timely communication with providers and patients. Staying organized and up-to-date with evolving payer requirements is essential to avoid delays or denials. Building strong collaboration with clinical teams and leveraging electronic health record systems can help streamline workflows and improve efficiency in the review process.

What is the difference between Authorization Utilization Review vs Claims Reviewer?

AspectAuthorization Utilization ReviewClaims Reviewer
CredentialsTypically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionalsOften requires similar credentials, focusing on insurance policies and claims processing
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, third-party administrators, healthcare organizations
Industry UsageUsed to assess medical necessity before approving servicesUsed to evaluate claims for payment accuracy and compliance

Authorization Utilization Review and Claims Reviewer roles both involve insurance and healthcare knowledge, but Authorization Utilization Review focuses on pre-authorization of services, while Claims Review centers on post-service claims assessment. Understanding these differences helps clarify career paths and job expectations in healthcare insurance.

What are popular job titles related to Authorization Utilization Review jobs in Florida?

For Authorization Utilization Review jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Authorization Utilization Review jobs in Florida look for?

The top searched job categories for Authorization Utilization Review jobs in Florida are:

What cities in Florida are hiring for Authorization Utilization Review jobs?

Cities in Florida with the most Authorization Utilization Review job openings:

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

RN, Utilization Management

UF Health

Saint Johns, FL • On-site

Temporary

Re-posted 17 days ago

Job description

Overview
Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
Responsibilities
Evaluates patient medical records to ensure necessity and appropriateness of healthcare services.
• Coordinates with healthcare providers to maintain compliance with utilization management guidelines.
• Optimizes treatment plans for effective patient care and resource utilization.
• Communicates authorization decisions clearly and supports timely discharge planning.
• Analyzes utilization data to identify trends and improve care coordination.
• Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.
Qualifications
Required Education. Graduate from an accredited Nursing school
Required experience: Registered Nurse (RN) license with 3+ years experience in utilization review or case management
Necessary Skills
• Knowledge of healthcare utilization guidelines and compliance
• Experience evaluating medical necessity and treatment plans
• Strong communication skills for authorization decisions
• Ability to analyze utilization data and support care coordination
License Requirement: Registered Nurse (RN) with a current Florida nursing license required.

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