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Entry Level Rn Utilization Review Nurse Jobs in Miami, FL

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Leon Health, Inc.

Concurrent Review Nurse

Miami, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills

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Entry Level Rn Utilization Review Nurse information

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How much do entry level rn utilization review nurse jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for entry level rn utilization review nurse in Miami, FL is $40.44, according to ZipRecruiter salary data. Most workers in this role earn between $31.97 and $46.44 per hour, depending on experience, location, and employer.
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Infographic showing various Entry Level Rn Utilization Review Nurse job openings in Miami, FL as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $84,116 per year, or $40.4 per hour.

Utilization Review Nurse

Health Business Solutions

Cooper City, FL • On-site

Other

Posted 28 days ago

Job description

Job Summary : We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment : Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination : Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.

  • Revenue Cycle Management : Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.

  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement : Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.

  • Data Analysis : Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.

  • Compliance : Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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