UTILIZATION REV SPEC I
Orlando, FL · On-site
Position Summary In this role, you will coordinate and manage insurance utilization review activities for hospitalized clients. You'll work closely with clinical teams, insurance representatives, and ...
Orlando, FL · On-site
Position Summary In this role, you will coordinate and manage insurance utilization review activities for hospitalized clients. You'll work closely with clinical teams, insurance representatives, and ...
Orlando, FL · On-site
Position Summary In this role, you will coordinate and manage insurance utilization review activities for hospitalized clients. You'll work closely with clinical teams, insurance representatives, and ...
Fort Lauderdale, FL · On-site +1
$30K - $40K/yr
Description Utilization Review Specialist (Part-Time - Weekends) Location: Remote Preferred ... Communicate with insurance case managers regarding benefits, coverage, and authorization status.
Fort Lauderdale, FL · On-site +1
$30K - $40K/yr
Description Utilization Review Specialist (Part-Time - Weekends) Location: Remote Preferred ... Communicate with insurance case managers regarding benefits, coverage, and authorization status.
Lauderdale Lakes, FL · On-site
$55K - $70K/yr
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...
Lauderdale Lakes, FL · On-site
$55K - $70K/yr
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...
Lauderdale Lakes, FL · On-site
$55K - $70K/yr
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...
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Lauderdale Lakes, FL · On-site
$55K - $70K/yr
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...
... insurance companies on concurrently denied and high risk for denial cases * Documentation ... in Utilization Review · Strong understanding of revenue cycle management and healthcare ...
... insurance companies on concurrently denied and high risk for denial cases * Documentation ... in Utilization Review · Strong understanding of revenue cycle management and healthcare ...
Cooper City, FL · On-site
... insurance companies on concurrently denied and high risk for denial cases * Documentation ... in Utilization Review · Strong understanding of revenue cycle management and healthcare ...
Cooper City, FL · On-site
... insurance companies on concurrently denied and high risk for denial cases * Documentation ... in Utilization Review · Strong understanding of revenue cycle management and healthcare ...
Lauderdale Lakes, FL · On-site
$55K - $70K/yr
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...
Lauderdale Lakes, FL · On-site
$55K - $70K/yr
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...
Orlando, FL · On-site
$90K - $98K/yr
As a Utilization Review Nurse (UR Nurse) , you'll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The UR Nurse is responsible for ...
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Orlando, FL · On-site
$90K - $98K/yr
As a Utilization Review Nurse (UR Nurse) , you'll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The UR Nurse is responsible for ...
The Manager, Utilization Review is responsible for overseeing the daily operations of the ... regulations, insurance processes, and quality improvement methodologies. • Proficiency in ...
The Manager, Utilization Review is responsible for overseeing the daily operations of the ... regulations, insurance processes, and quality improvement methodologies. • Proficiency in ...
Boca Raton, FL · On-site +1
$50K - $80K/yr
No prior utilization review experience is required. Training will be provided for the right ... Conduct daily phone contact with insurance companies to secure authorizations for behavioral health ...
Boca Raton, FL · On-site +1
$50K - $80K/yr
No prior utilization review experience is required. Training will be provided for the right ... Conduct daily phone contact with insurance companies to secure authorizations for behavioral health ...
Must be familiar with a variety of insurances and funding streams, including commercial insurance ... Utilization Review position, such as: * Challenging and rewarding work environment * Competitive ...
Must be familiar with a variety of insurances and funding streams, including commercial insurance ... Utilization Review position, such as: * Challenging and rewarding work environment * Competitive ...
The Director of Utilization Management is also responsible for ensuring that the utilization review ... Must be familiar with a variety of insurances and funding streams, including commercial insurance ...
The Director of Utilization Management is also responsible for ensuring that the utilization review ... Must be familiar with a variety of insurances and funding streams, including commercial insurance ...
Miami, FL · On-site +1
Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers ... Minimum 7 years of relevant experience (5 years of case management/utilization review experience ...
Miami, FL · On-site +1
Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers ... Minimum 7 years of relevant experience (5 years of case management/utilization review experience ...
Miami, FL · On-site
Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers ... Minimum 7 years of relevant experience (5 years of case management/utilization review experience ...
Miami, FL · On-site
Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers ... Minimum 7 years of relevant experience (5 years of case management/utilization review experience ...
Must have 2 years minimum experience in at least one of the following: utilization review from another managed care company; experience in a medical setting handling coordinating with insurance ...
Must have 2 years minimum experience in at least one of the following: utilization review from another managed care company; experience in a medical setting handling coordinating with insurance ...
Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers ... Minimum 7 years of relevant experience (5 years of case management/utilization review experience ...
Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers ... Minimum 7 years of relevant experience (5 years of case management/utilization review experience ...
Responsibilities The Utilization Review Director is responsible for directing and overseeing the ... insurance offering, a physician network and various related services located all over the U.S.
Responsibilities The Utilization Review Director is responsible for directing and overseeing the ... insurance offering, a physician network and various related services located all over the U.S.
Job Purpose: - The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible ... LifeStream Benefits * Health/Dental/Vision Insurance * Short Term Disability * Pension Plan ...
Job Purpose: - The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible ... LifeStream Benefits * Health/Dental/Vision Insurance * Short Term Disability * Pension Plan ...
Leesburg, FL · On-site
$34.05/hr
Job Purpose: - The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible ... LifeStream Benefits * Health/Dental/Vision Insurance * Short Term Disability * Pension Plan ...
Leesburg, FL · On-site
$34.05/hr
Job Purpose: - The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible ... LifeStream Benefits * Health/Dental/Vision Insurance * Short Term Disability * Pension Plan ...
The URS establishes a file on all incoming clients with insurance and maintains authorization for reimbursement from pre-certification through continuing stay reviews, through discharge of referral.
The URS establishes a file on all incoming clients with insurance and maintains authorization for reimbursement from pre-certification through continuing stay reviews, through discharge of referral.
$15.99 - $19.22
2% of jobs
$19.22 - $22.45
9% of jobs
$24.67 is the 25th percentile. Wages below this are outliers.
$22.45 - $25.69
21% of jobs
The median wage is $28.31 / hr.
$25.69 - $28.92
23% of jobs
$28.92 - $32.16
13% of jobs
$34.67 is the 75th percentile. Wages above this are outliers.
$32.16 - $35.39
10% of jobs
$35.39 - $38.62
8% of jobs
$38.62 - $41.86
5% of jobs
$41.86 - $45.09
5% of jobs
$45.09 - $48.32
2% of jobs
$48.32 - $51.56
2% of jobs
$15
$31
$51
One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.
To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.
An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

4.8
Based on 5 frontline employees who took The Breakroom Quiz
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Health care and social assistance
501 - 1,000 Employees
Orlando, FL, US
2014