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Hca Utilization Review Jobs (NOW HIRING)

Cooperidge Consulting Firm

Perform utilization management reviews and communicate crucial information to third-party payors ... Ensure compliance with all regulatory requirements, HCA Ethics and Compliance policies, and quality ...

Cooperidge Consulting Firm

Perform utilization management reviews and communicate crucial information to third-party payors ... Ensure compliance with all regulatory requirements, HCA Ethics and Compliance policies, and quality ...

Star Nursing

RN - Case Manager

Gainesville, FL · On-site

HCA Florida North Florida Hospital Available Shifts: • Day shift: 8:00 AM - 4:30 PM with Rotating ... Participates in IDT rounds, Conducts utilization review, evaluates clinical information, and ...

MTK HealthCare

RN - Case Manager

Gainesville, FL · On-site

HCA Florida North Florida Hospital Available Shifts: • Day shift: 8:00 AM - 4:30 PM with Rotating ... Participates in IDT rounds, Conducts utilization review, evaluates clinical information, and ...

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How much do hca utilization review jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for hca utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is an HCA Utilization Review job?

An HCA Utilization Review job involves evaluating medical services to ensure they are necessary, cost-effective, and meet quality standards. Professionals in this role review patient records, coordinate with healthcare providers, and ensure treatments align with insurance guidelines and hospital policies. They play a key role in optimizing resource utilization, preventing unnecessary procedures, and ensuring compliance with regulations. Strong analytical skills and knowledge of medical terminology are essential for success in this position.

What are the key skills and qualifications needed to thrive in the Hca Utilization Review position, and why are they important?

To thrive as a HCA Utilization Review professional, you need a solid foundation in medical terminology, clinical assessment, and insurance guidelines, often supported by a healthcare-related degree or nursing license. Familiarity with utilization review software, electronic health records (EHR) systems, and certifications like CCM (Certified Case Manager) are highly beneficial. Excellent analytical thinking, attention to detail, and strong communication skills help you effectively evaluate patient records and collaborate with providers. These competencies are key to ensuring appropriate care utilization, supporting cost-effective treatment decisions, and maintaining regulatory compliance.

What does a typical day look like for someone working in HCA Utilization Review?

In HCA Utilization Review, your day usually involves reviewing patient medical records, assessing the necessity and appropriateness of proposed treatments, and communicating decisions to physicians and case managers. You may also participate in interdisciplinary meetings, liaise with insurance providers for authorization, and document your findings in healthcare management systems. The role is collaborative, requiring you to interact with diverse medical and administrative teams to align patient care with policy guidelines. This blend of independent evaluation and team collaboration makes each day varied and impactful for patient outcomes.

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Hca Utilization Review jobs near you
Infographic showing various Hca Utilization Review job openings in the United States as of May 2026, with employment types broken down into 76% Full Time, 6% Part Time, and 18% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Case Manager RN

Cooperidge Consulting Firm

Woodville, FL • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

Cooperidge Consulting Firm is seeking a Case Manager Registered Nurse (RN) for a top Healthcare client.

The RN Case Manager (CM) serves as a Care Coordinator, facilitating the interdisciplinary plan of care with a focus on evaluating clinical appropriateness, medical necessity, level of care, and resource utilization. This role coordinates activities that promote quality outcomes and efficient patient throughput, identifies barriers to care, and assumes a leadership role in developing effective discharge plans.
Job Responsibilities

  • Perform comprehensive assessments of the psychosocial and medical needs of assigned patients to develop a detailed case management plan of care.
  • Evaluate admissions for medical necessity and appropriate observation status using approved criteria, escalating issues through the established chain of command as needed.
  • Assume a leadership role with the interdisciplinary team to manage care, ensuring appropriate level of care, patient status, and resource utilization are maintained.
  • Facilitate patient throughput with an ongoing focus on quality and efficiency, coordinating services necessary to meet identified post-discharge needs.
  • Track and trend variances and barriers to care, making recommendations and developing action plans to improve processes and systems across the continuum.
  • Perform utilization management reviews and communicate crucial information to third-party payors, acting as a liaison between all parties (physicians, hospital staff, outside agencies).
  • Ensure compliance with all regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to the provision of Case Management Services.
  • Document professional recommendations, care coordination interventions, and case management activities accurately to ensure effective communication across the healthcare team.

Requirements

Education
  • Associate's Degree in Nursing or Diploma in Nursing is required.
  • Bachelor’s Degree in Nursing is preferred.
Experience
  • Option 1 (Direct CM): Minimum of 3 years of RECENT (within the last year) Case Manager experience in an acute care setting is required.
  • Option 2 (Unit Experience): Minimum of 3 years of recent RN experience in Med/Surg, Telemetry, Neuro, ICU, PCU, or ED is required.
  • Option 3 (Non-Acute CM): Case Manager experience in home health or insurance will be considered, but requires a total of 3 years of acute care experience, with at least 1 year of that acute care experience being within the last 5 years.
Certifications/Licenses
  • Current FL RN license or appropriate compact licensure is required. If compact, an active FL RN license is required within 90 days of hire.
  • Advanced Practice Registered Nurse (APRN) license is acceptable.
  • Certification in Case Management, Nursing, or Utilization Review is preferred.
Skills
  • Proven ability to assume a leadership role with an interdisciplinary team to manage care coordination and resource utilization.
  • Strong knowledge of utilization review criteria, regulatory requirements, and discharge planning processes.
  • Effective and professional communication skills for acting as a liaison between multiple stakeholders (physicians, payors, families).

Benefits

  • Competitive pay with opportunities for overtime and weekend shifts.
  • Comprehensive medical, dental, and vision insurance.
  • Life insurance and disability coverage.
  • 401(k) retirement plan with employer match.
  • Paid time off — vacation, sick leave, and holidays.
  • Continuing education and professional development opportunities.
  • Supportive, team-oriented work environment.