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Chart Utilization Review Jobs in Florida (NOW HIRING)

UHS

UM COORDINATOR (PRN) - Weekdays

Orlando, FL · On-site

Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.

UHS

UM COORDINATOR (PRN) - Weekdays

Orlando, FL · On-site

Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.

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Chart Utilization Review information

What are the key skills and qualifications needed to thrive as a Chart Utilization Review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is Chart Utilization Review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in Chart Utilization Review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Florida? For Chart Utilization Review jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Florida look for? The top searched job categories for Chart Utilization Review jobs in Florida are:
What cities in Florida are hiring for Chart Utilization Review jobs? Cities in Florida with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Florida as of July 2026, with employment types broken down into 2% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.
Utilization Review Nurse

Utilization Review Nurse

Healthcare Support Staffing

Tampa, FL

$29 - $30/hr

Full-time

Re-posted 24 days ago

Job description

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

You, as the Nurse Reviewer will be held responsible for the comprehensive review of the medical information for the assigned medical record review and completion of all paperwork, communication and data entry involved. Reviews will include quality of care, medical necessity; DRG validation, focused, readmission, Emergency Medical Treatment and Active Labor Act [EMTALA], and all others are required by contract. Communicates with the Medicare beneficiary/family members, healthcare providers and/or practitioners as needed during the course of the identified review.

Essential Duties:

Maintains current knowledge of the QIO contract, QIO Manual, SDPS Memorandums and Healthcare Communities Website to locate and apply up to date rules and protocols

Recognizes barriers to completing work and uses clinical judgment to determine when to seek assistance from the Review Supervisor

Communicates with the providers/practitioners via mail or phone regarding the need for clarification of requests and information provided in the correspondence letters.

Responds in a timely manner to the providers and/or practitioners if there is a request for information or assistance in order to facilitate the completion of the assigned medical record reviews.

Applies knowledge and expertise, analytical skills, critical thinking and business acumen to best meet customer needs.

Communicates with Medicare beneficiary via mail or phone as needed

Responds in a timely manner to the beneficiary if there is a request for information

Frequently seeks and accepts feedback with regards to the review process; listens actively; maintains frequent and open communication.

Collaborates to accomplish common goals to include accurate medical assessment of the beneficiary complaint and accurate Quality of Care Reviews.

Recommend actions that may increase quality /productivity related to the review process.

Communicates the current status of workload and availability for additional assignments

Collaborates with the KEPRO team to identify additional process improvements that support enhanced beneficiary satisfaction and overall improvement of heal care.

Collaborates with the KEPRO staff to support all contract requirements and identify additional contract improvements.


Qualifications

Active RN or LPN Licensure

Graduate from an accredited School of Nursing or college

3+ years of clinical experience within any healthcare setting [Acute Care, Inpatient, Outpatient, etc]

Quality Review experience [Medical Necessity, Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews]


Additional Information

Shift: Monday - Friday 8:00am - 5:00pm

This is an immediate contract opening!

Pay range $29.00 - $30.00/hr), salary negotiated based on relevant experience


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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