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 ...
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 ...
... insurance coverage of each patient • Organize weekend census of all detox and residential ... Utilization Review Specialist Schedule: • Full Time, Friday - Monday (weekends) with potential ...
... insurance coverage of each patient • Organize weekend census of all detox and residential ... Utilization Review Specialist Schedule: • Full Time, Friday - Monday (weekends) with potential ...
Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...
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Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...
Utilization Review Specialist
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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Utilization Review Specialist
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 ...
Utilization Review Specialist
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 ...
Utilization Review Specialist
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 ...
Utilization Review Specialist
$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 ...
Utilization Review Specialist
$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 ...
Utilization Review Specialist
Pompano Beach, FL · Remote
$45K - $65K/hr
Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...
Utilization Review Specialist
Pompano Beach, FL · Remote
$45K - $65K/hr
Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...
Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...
Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...
Utilization Review Specialist
Tampa, FL · On-site
Utilization Review Specialist Your experience matters: At Tampa General Behavioral Health Hospital ... UR contacts external case managers/managed care organizations for certification of insurance ...
Utilization Review Specialist
Tampa, FL · On-site
Utilization Review Specialist Your experience matters: At Tampa General Behavioral Health Hospital ... UR contacts external case managers/managed care organizations for certification of insurance ...
Utilization Review Specialist
Tampa, FL · On-site
Utilization Review Specialist Your experience matters: At Tampa General Behavioral Health Hospital ... UR contacts external case managers/managed care organizations for certification of insurance ...
Utilization Review Specialist
Tampa, FL · On-site
Utilization Review Specialist Your experience matters: At Tampa General Behavioral Health Hospital ... UR contacts external case managers/managed care organizations for certification of 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 ...
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 ...
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 ...
Healthcare Utilization Review Specialist
Orlando, FL · On-site
$22 - $24/hr
As a Healthcare Utilization Review Specialist, you'll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self-funded insurance programs.
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Healthcare Utilization Review Specialist
Orlando, FL · On-site
$22 - $24/hr
As a Healthcare Utilization Review Specialist, you'll play a vital role in ensuring our clients and members receive the right care at the right time through customized, self-funded insurance programs.
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.
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 ...
Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$60K - $75K/yr
Comprehensive benefits package, including medical, dental, and vision insurance. * Paid time off ... Prior experience in utilization review, case management, or insurance authorization within the ...
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Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$60K - $75K/yr
Comprehensive benefits package, including medical, dental, and vision insurance. * Paid time off ... Prior experience in utilization review, case management, or insurance authorization within the ...
Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$60K - $75K/yr
Comprehensive benefits package, including medical, dental, and vision insurance. * Paid time off ... Prior experience in utilization review, case management, or insurance authorization within the ...
Quick apply
Utilization Review Specialist (in-office only)
Boca Raton, FL · On-site
$60K - $75K/yr
Comprehensive benefits package, including medical, dental, and vision insurance. * Paid time off ... Prior experience in utilization review, case management, or insurance authorization within the ...
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 ...
Utilization Review Manager (On-site) (279)
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 ...
Utilization Review Manager (On-site) (279)
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 ...
Utilization Review Specialist (in-office only) (Boca Raton)
Boca Raton, FL · On-site
$60K - $75K/yr
Comprehensive benefits package, including medical, dental, and vision insurance. * Paid time off ... Prior experience in utilization review, case management, or insurance authorization within the ...
Utilization Review Specialist (in-office only) (Boca Raton)
Boca Raton, FL · On-site
$60K - $75K/yr
Comprehensive benefits package, including medical, dental, and vision insurance. * Paid time off ... Prior experience in utilization review, case management, or insurance authorization within the ...
Insurance Utilization Review information
See Florida salary details
$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
How much do insurance utilization review jobs pay per hour?
What are the most common challenges faced by Insurance Utilization Review professionals?
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.
What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?
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.
What is an Insurance Utilization Review job?
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.
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- Remote Utilization Management Nurse
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Aspire Health Partners rating
4.8
Based on 5 frontline employees who took The Breakroom Quiz
Job description
Behavioral Health Utilization Review Specialist I
Aspire Health Partners, Inc.
Make a Difference in Behavioral Health Care
At Aspire Health Partners, we are dedicated to transforming lives through compassionate, high-quality behavioral healthcare. As Florida's largest nonprofit behavioral health provider, we serve diverse populations across Central Florida and are committed to clinical excellence and meaningful impact.
We are currently seeking a Utilization Review Specialist to join our team and play a key role in ensuring our clients receive the care they need while supporting effective coordination with insurance providers.
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 internal departments to ensure timely authorizations, support treatment planning, and contribute to high-quality patient outcomes.
Key Responsibilities
- Partner daily with the Access Center and/or Crisis Response Center (CRC) to identify clients needing utilization review
- Communicate clinical information to insurance reviewers to secure authorizations and extended lengths of stay
- Collaborate with attending psychiatrists on clinical assessments and treatment recommendations
- Participate in interdisciplinary treatment team meetings to support care for managed care clients
- Provide constructive clinical feedback to enhance service delivery and patient care
- Ensure accurate authorization details are submitted to Patient Accounts for billing
- Review client charts for potential denial issues and support appeal processes when needed
- Maintain strict adherence to ethical standards, confidentiality, and organizational policies
Required:
- High School Diploma or equivalent
- Level II Background clearance- All Aspire Health Partners Internships and Careers require Level 2 clearance, with Aspire covering fingerprinting costs. Click https://info.flclearinghouse.c... to learn more.
- Valid driver's license with an acceptable driving record per organizational guidelines
- Experience in behavioral health, utilization review, or managed care environments
- LPN or RN experience
- Strong communication, documentation, and organizational skills
- Mission-driven organization making a real impact in your community
- Collaborative, team-focused work environment
- Opportunities for growth and professional development
- A role where your work directly supports quality care and patient outcomes
Equal Opportunity Employer
Aspire Health Partners is a drug-free workplace and an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will be considered without regard to race, color, religion, national origin, sex, age, disability, or veteran status.
About Aspire Health Partners
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
501 - 1,000 Employees
Headquarters location
Orlando, FL, US
Year founded
2014