ZipRecruiter

Log In

1

Insurance Review Nurse Jobs in Florida (NOW HIRING)

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. In the ... Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. In the ... Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. In the ... Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ...

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 ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

CES, LLC

Medical Review Nurse III

Saint Augustine, FL · Remote

Summary: The Medical Reviewer will utilize Medicare and/or Medicaid rules, regulations, and ... Graduate from an accredited school of nursing and has an active license as a Registered Nurse ...

Talent4Health

RN - Utilization Review

Fort Myers, FL · On-site

$2.0K/wk

... Offering Nursing Profession RN Specialty Utilization Review Job ID 37756438 Job Title RN - ... Insurance Portability and Accountability Act (HIPAA) and other relevant privacy laws.

next page

Showing results 1-20

All JobsInsurance Review Nurse JobsInsurance Review Nurse Jobs in Florida

Insurance Review Nurse information

See Florida salary details

$15.4K

$39.4K

$62.1K

How much do insurance review nurse jobs pay per year?

As of Aug 30, 2026, the average yearly pay for insurance review nurse in Florida is $39,420.00, according to ZipRecruiter salary data. Most workers in this role earn between $29,200.00 and $46,300.00 per year, depending on experience, location, and employer.

What is an insurance review nurse?

Insurance Review Nurses are registered nurses who evaluate medical records and treatment plans to determine if healthcare services are medically necessary and covered by insurance policies. They act as a liaison between healthcare providers, patients, and insurance companies to ensure that claims meet policy guidelines. Their work helps prevent unnecessary treatments and controls healthcare costs while ensuring patients receive appropriate care.

What skills and qualifications are needed to be an insurance review nurse?

To thrive as an Insurance Review Nurse, you need a registered nursing license, strong clinical knowledge, and experience in case management or utilization review. Familiarity with medical coding systems (such as ICD-10 and CPT), healthcare regulations, and insurance software platforms is typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for evaluating medical records and collaborating with providers. These skills ensure accurate, efficient reviews that support appropriate coverage decisions and compliance with regulatory standards.

What challenges do insurance review nurses face when evaluating medical necessity for insurance claims?

Insurance Review Nurses often encounter challenges such as interpreting complex medical records, staying current with evolving insurance policies and clinical guidelines, and balancing the interests of patients, providers, and insurers. They must exercise critical thinking to make impartial decisions while navigating tight deadlines and high caseloads. Collaborating effectively with physicians, case managers, and claims adjusters is crucial to ensure accurate and fair assessments.

What is the difference between Insurance Review Nurse vs Claims Nurse?

AspectInsurance Review NurseClaims Nurse
CredentialsRN license, possibly certifications in case management or insuranceRN license, certifications in case management or insurance
Work EnvironmentReviewing insurance claims, assessing coverage, working with insurance companiesHandling patient claims, coordinating with insurance providers, clinical assessments
Employer & IndustryInsurance companies, third-party administratorsHospitals, insurance companies, healthcare providers

Both roles require RN licensure and similar certifications, often working within insurance or healthcare settings. Insurance Review Nurses primarily evaluate insurance claims for coverage and compliance, while Claims Nurses handle patient claims, ensuring proper processing and coordination. Although their tasks differ, both roles focus on insurance and healthcare integration, making them closely related in the industry.

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

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

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

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

Insurance Review Nurse jobs near you
Infographic showing various Insurance Review Nurse job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $39,420 per year, or $19 per hour.

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Re-posted 22 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.

Apply