ZipRecruiter

Log In

1

Concurrent Review Jobs in Florida (NOW HIRING)

Independent Living Systems

Physician Reviewer

Miami, FL · On-site

Review requests for prior authorizations, inpatient and concurrent review, outpatient and procedural requests, and long term care services by analyzing medical records, clinical data, and treatment ...

Fabergent

Clinical Care Reviewer

Doral, FL · On-site

Adheres to Process Standards, Standard Operating Procedures, and Policies and Procedures, as defined by specific UM role (Prior Authorization, Concurrent Review) Submits appropriate documentation ...

previous pagenext page

Showing results 21-40

All JobsConcurrent Review JobsConcurrent Review Jobs in Florida

Concurrent Review information

What is concurrent review in healthcare?

Concurrent review is a process used in healthcare to assess the necessity and appropriateness of ongoing inpatient care while the patient is still hospitalized. The goal is to ensure that medical services are being delivered efficiently and according to established guidelines. Utilization review nurses or case managers typically conduct these reviews by evaluating medical records, communicating with providers, and making recommendations regarding continued stay or discharge planning. This helps control healthcare costs and improves patient outcomes by preventing unnecessary treatments or extended hospitalizations.

What are some common challenges faced by concurrent review nurses, and how can they be managed?

Concurrent Review nurses often face challenges such as managing a high volume of case reviews within tight deadlines and ensuring timely communication with providers and insurance companies. Staying organized, utilizing efficient documentation systems, and maintaining up-to-date knowledge of regulatory requirements can help overcome these hurdles. Collaboration with interdisciplinary teams and regular training on evolving guidelines are also essential for success in this role.

What are the key skills and qualifications needed to thrive as a concurrent review nurse, and why are they important?

To thrive as a Concurrent Review Nurse, you need a strong clinical background, current RN licensure, and a thorough understanding of utilization management and healthcare regulations. Familiarity with case management software, electronic health records (EHRs), and knowledge of insurance guidelines and ICD/CPT coding is typically required. Excellent analytical thinking, communication skills, and attention to detail help in collaborating with providers and ensuring appropriate care. These competencies are crucial for ensuring patients receive medically necessary care while maintaining compliance and cost-effectiveness.

What is the difference between Concurrent Review vs Utilization Review?

AspectConcurrent ReviewUtilization Review
PurposeAssess ongoing patient care during hospitalizationEvaluate the necessity and appropriateness of services, often before or after care
TimingPerformed in real-time during treatmentCan be pre-authorization, concurrent, or retrospective
Work EnvironmentHospitals, clinics, insurance companiesInsurance companies, healthcare organizations
CredentialsRegistered nurses, case managers, healthcare professionalsMedical reviewers, nurses, case managers

Concurrent Review focuses on evaluating ongoing patient care during hospitalization, ensuring treatments are appropriate in real-time. Utilization Review has a broader scope, including pre-authorization and retrospective assessments to determine the necessity of services. While both roles involve healthcare professionals and are used within insurance and healthcare settings, their timing and specific focus differ.

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

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

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

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

Concurrent Review jobs near you
Infographic showing various Concurrent 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.

Senior Utilization Review Specialist - Part Time

Sage Clinical RCM, LLC

Gulfport, FL • On-site

Part-time

Posted 10 days ago

Job description

Description: Position Summary

The Part Time Senior Utilization Review Specialist is an experienced registered nurse responsible for concurrent and retrospective review of hospital services to support appropriate utilization, accurate patient status, timely payer authorization, and medical necessity compliance. This senior individual-contributor role serves as a clinical resource for complex cases and partners with physicians, care management, patient access, coding, and revenue cycle teams to reduce avoidable denials and support appropriate reimbursement.

Key Responsibilities

• Perform concurrent and retrospective utilization review for assigned inpatient, observation, and outpatient cases using approved criteria, payer policies, and clinical judgment.

• Apply InterQual, MCG, or client-approved criteria to support medical necessity, level of care, continued stay, and patient-status determinations.

• Obtain, submit, and track payer notifications and authorizations; communicate clinically relevant information to payer medical-management teams within required time frames.

• Identify potential medical-necessity, authorization, status, and documentation risks early and escalate appropriately to prevent avoidable denials.

• Collaborate with physicians, case management, CDI, coding, patient access, and revenue cycle partners to clarify documentation and support appropriate care progression.

• Coordinate clinical information and deadlines for peer-to-peer review or denial escalation when needed; maintain complete, accurate documentation in the designated systems.

• Serves as a member of the Utilization Review Committee-prepares reports to include utilization trends, denial patterns, extended stays, and workflow barriers; communicate actionable findings to leadership.

• Performs escalations to UR Committee members to ensure that compliance with regulations for patient status changes by providers are occurring per policy. Documents escalations and presents outcomes to UR committee.

• Serve as a senior clinical resource, providing guidance and support on complex review questions while adhering to established policies and escalation pathways.

• Participate in quality audits, education, process improvement, and other initiatives that strengthen utilization management performance.

Requirements: Required Qualifications

• Current, unrestricted RN license.

• Five or more years of acute-care hospital experience, including at least three years in utilization review, utilization management, case management, or a closely related function.

• Demonstrated experience applying medical-necessity and level-of-care criteria, including concurrent review and continued-stay review.

• Working knowledge of inpatient versus observation status, payer authorization requirements, Medicare and managed-care utilization principles, and denial-prevention practices.

• Strong clinical judgment, prioritization, documentation, communication, and collaborative problem-solving skills.

• Ability to independently manage a high-volume, deadline-driven caseload while exercising sound judgment regarding escalation.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).

• Certification in case management or utilization management, such as CCM or ACM.

• Experience with InterQual, MCG, Cerner, or comparable utilization-management and electronic health-record systems.

• Experience supporting hospital denials management, peer-to-peer coordination, or care-progression initiatives.


Role Boundaries and Work Expectations

• This is a senior individual-contributor role and does not include direct people management unless separately assigned.

• The specialist follows St. John's Health clinical policies, payer requirements, and established Sage Clinical RCM workflows.

• The role requires discretion with protected health information and strict compliance with HIPAA, client security standards, and applicable regulations.

• Availability during agreed hospital business hours and participation in required meetings, education, and workflow updates are expected.