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Chart Utilization Review Jobs in Florida (NOW HIRING)

UHS

UM COORDINATOR (FT)

Orlando, FL

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 (FT)

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 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 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 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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Specialist

We Level Up NJ

Deerfield Beach, FL • On-site, Remote

$50K - $90K/yr

Full-time

Posted 16 days ago

Job description

Position Summary:
Responsible completion of assigned tasks related to preadmission reviews, continued stay reviews, medical necessity requests, and chart audit requests. Supports the organization's commitment to the principle that providing the most appropriate services, in the least restrictive environment, utilizing proven clinical interventions will lead to the provision of safe and effective care, treatment, or services to meet the individual's treatment and recovery needs.
Position Responsibilities:
  • Completes Preadmission Assessment and/or admission assessment to obtain necessary treatment authorizations.
  • Works with call center and admission staff to obtain, review, assess, and clarify any data, assessment, and/or information that helps develop a full and clear picture of the client's issues, problems, challenges, mental status, and medical status that will indicate the appropriate level of care required to treat his/her presenting condition safely and effectively.
  • Completes Concurrent Reviews as required by payor sources, case management company or other intermediary entity to ensure ongoing communication and preauthorization of services. This level of review will occur as needed throughout the client's treatment.
  • Arranges for Peer Reviews as requested will coordinate both internal and external peer review process as needed or requested to ensure proper care, treatment, or services. These services may occur at any time during the client's treatment.
  • Coordinate's provision of Letters of Medical Necessity as needed under the following circumstances:
    • Requested by, or to respond to, insurance company
    • Requested by the billing company
    • Identified as important to support billing and/or UR process.
  • Screens all intake files for documented discharge plan to communicate information to insurance provider as needed. Stays informed of discharge planning issues and changes.
  • Will be available to clinical team, medical team, referral sources, and others as needed to provide guidance and consultation regarding placement criteria, level of care, appropriateness of services, coordination of care, and discharge planning.
  • Knowledge of Medical Necessity Criteria including ASAM, and other protocols utilized by payor sources.
  • Knowledgeable of Levels of Care Criteria as defined by the level of medical and clinical supervision or direct care required of that setting. Levels of care offered by the facility include Residential Detox and Residential Treatment.
  • Coordinates Physician Reviewer or Peer Review calls as needed to perform MD to MD calls as needed.
  • Participates in Utilization Review Committee or other committees as needed to present trends and issues.
  • Develops, tracks, and manages Dashboard Reports as needed to track and trend key performance indicators.
  • Works well with insurance companies, payors, benefits management, case management and other sources to ensure a collaborative relationship.
  • Strong knowledge of medical terminology and medical record documentation. General understanding of laboratory results, frequently used medications, and other basic medical issues.
  • Manages discharge dates under the supervision of the manager. Works with operations managers at each facility to assist in smooth transitions for patients.
  • Aids the UR Manager in assigning precertification to UR Coordinators and UR Associates.
  • Trains new hires in the UR department and evaluates their performance during probationary period.
  • Demonstrates competence in one or more of the following areas:
    • Establishing rapport, systematically gathering assessment data, evaluating readiness for treatment and change, and applying accepted diagnostic criteria for substance use disorders.
    • Screening for psychoactive substance toxicity, intoxication, and withdrawal symptoms.
    • Screening for co-occurring mental health conditions.
  • Supports the organization's efforts to comply with National Patient Safety Goals related to:
    • Infection prevention
    • Suicide risk assessment
    • Patient identification
    • Medication reconciliation
  • Performs additional responsibilities as assigned by leadership.

Workplace Behaviors
  • Demonstrates the ability to complete daily tasks as assigned and meet required deadlines.
  • Complies consistently with attendance and punctuality standards.
  • Safeguards client rights to privacy and confidentiality at all times.
  • Preserves the personal dignity and respect of all clients.
  • Maintains a positive, professional, and supportive attitude in the workplace.
  • Provides leadership by coaching, supporting, and motivating staff.
Workplace Responsibility
  • Seeks supervision, guidance, or direction when necessary.
  • Demonstrates initiative in carrying out assigned responsibilities.
  • Actively participates in committees and organizational activities as assigned.
Adaptability
  • Demonstrates the ability to work objectively and maturely under stress.
  • Performs in other capacities as needed to support operational needs.
  • Responds positively and professionally to changing workplace situations.
  • Actively participates in coaching and makes appropriate corrections to work processes.
  • Participates in emergency management and response processes as required.
Professionalism
  • Performs duties in a professional manner and consistently conveys a positive image of the mental health profession.
  • Works effectively as a collaborative member of the team.
  • Complies with organizational dress code and professional appearance standards.
Ongoing Training & Development
  • Attends all required in-service trainings and educational courses.
  • Assumes responsibility for individual professional growth.
  • Contributes to the professional development of colleagues.
Communication
  • Seeks and responds constructively to feedback and supervision.
  • Develops, interprets, and communicates required policies and procedures appropriately.
  • Recognizes and takes appropriate action regarding violations of facility policies and procedures, especially those impacting safety.
  • Actively participates as a member of assigned organizational teams.
  • Participates in facility performance improvement activities.
  • Establishes appropriate rapport with coworkers, clients, and visitors.
  • Clearly communicates job-related concerns to supervisors and during staff meetings.
  • Consistently reports critical information to supervisors, particularly regarding client care, equipment issues, and supply needs.
  • Seeks guidance from appropriate leadership when facility-related issues arise.
  • Reports all incidents promptly and completes accurate incident documentation.

Safety, Risk Management, Infection Control & Regulatory Compliance
  • Reports any personal symptoms of suspected illness or contagious disease to a supervisor in a timely manner.
  • Consistently utilizes proper hand hygiene and infection prevention techniques.
  • Reports all incidents and near-misses in accordance with organizational policies and procedures.
  • Adheres to all facility policies, procedures, and safety protocols.
  • Maintains a safe, clean, and secure physical environment at all times.
  • Ensures appropriate protection of client confidentiality in accordance with HIPAA and organizational standards.
  • Complies with all Joint Commission Standards applicable to the role.
  • Complies with all State Licensing and Regulatory Guidelines.
  • Actively participates in Performance Improvement (PI) and Quality Assurance (QA) activities.
Substance Abuse Competency
  • Staff who assess, plan services for, and provide care to individuals with substance use disorders demonstrate the knowledge and skills to:
  • Establish rapport, systematically gather data, assess readiness for treatment and change, and apply accepted diagnostic criteria for substance use disorders.
  • Screen for psychoactive substance toxicity, intoxication, and withdrawal symptoms.
  • Screen for danger to self or others.
  • Screen for co-occurring mental health conditions.
  • Analyze and interpret assessment data to determine treatment recommendations and clinical priorities.
  • Collaborate with the individual served to formulate mutually agreed-upon, measurable treatment goals and objectives.
  • Demonstrate adherence to accepted ethical, professional, and behavioral standards of conduct.
  • Participate in continuing professional development and ongoing competency training.
Mental Health Competency
  • Staff who assess, plan services for, and deliver care to individuals with mental health conditions demonstrate the knowledge and skills to:
  • Establish rapport, systematically gather data, assess readiness for treatment and change, and apply accepted diagnostic criteria for mental disorders.
  • Screen for common symptoms of mental illness and psychiatric instability.
  • Demonstrate working knowledge of general DSM terminology and diagnostic language.
  • Demonstrate understanding of common mental health risk factors.
  • Screen for suicidality, self-harm, and other high-risk behaviors.
  • Analyze and interpret assessment data to determine treatment recommendations and clinical priorities.
  • Collaborate with the individual served to develop mutually agreed-upon, measurable treatment goals and objectives.
  • Demonstrate adherence to accepted ethical, clinical, and professional standards of conduct.
  • Participate in ongoing continuing education and professional development activities.

Licensures and/or Certifications
  • Professional License or Certification relevant to Degree.

Education and Experience:
  • High School Diploma or equivalent required.
  • Associate or Bachelor's Degree in healthcare related studies preferred.
  • Minimum of 2 years of experience in utilization review services in substance abuse treatment, behavioral health care, or health care.

Requirements:
TECHNOLOGY
General knowledge of:
Excel, WORD, and Power Point, KIPU, Email, Tablet, and general desktop applications.
EQUIPMENT
Computer, calculator, Fax Machine, copy machine, telephone system, ID camera, cell phone.
VEHICLE OPERATIONS
Valid driver's license
AGE SPECIFIC CONSIDERATIONS
Adults 18 years or above
ENVIRONMENTAL CONDITIONS
Controlled environment temperature with 80%-90% of the time spent indoors.
JOB CATEGORY STANDARD PRECAUTIONS
Universal precautions
PERSONAL PROTECTIVE EQUIPMENT
None
POTENTIAL WORKPLACE HAZARDS
Normal Workplace Hazards
POTENTIAL WORKPLACE VIOLENCE
Low/Medium
SPECIAL CERTIFICATIONS
CPR Certification (if applicable)
PHYSICAL DEMANDS
Physical Tasks
0-25%
26-50%
51-75%
76-100%
Standing
X
Walking
X
Bending
X
Crouching
X
Carrying
X
Pushing
X
Pulling
X
Sitting
X
Reaching
X
Reading
X
Driving
X
LIFTING/LOWERING
Light (1-20 lbs)
X
Medium (21-50 lbs)
X
Heavy (51+ lbs)
X

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