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Insurance Utilization Review Jobs in Miami, FL (NOW HIRING)

Uloop Inc.

Care Review Clinician (RN)

Miami, FL · On-site

$36.38 - $85.12/hr

... insurance policies, and regulations - ensuring members reach desired outcomes through integrated ... Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least ...

New

Molina Healthcare

Care Review Clinician, ABA

Miami, FL · On-site

$26.41 - $51.49/hr

... insurance policies, and regulations - ensuring members reach desired outcomes through integrated ... Works collaboratively with the utilization and care management departments to provide ABA and ...

Molina Healthcare

Care Review Clinician, ABA

Miami, FL · On-site

$26.41 - $51.49/hr

... insurance policies, and regulations - ensuring members reach desired outcomes through integrated ... Works collaboratively with the utilization and care management departments to provide ABA and ...

The Hartford

Behavioral Health Case Manager

Sunrise, FL · Hybrid

$74K - $112K/yr

Preference for managed care/utilization review/insurance experience. * Preference for crisis intervention skills. * Solid technical acumen with Microsoft Office: Word, Excel & PowerPoint. * Ability ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Miami, FL

Insurance Utilization Review information

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$20

$40

$65

How much do insurance utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for insurance utilization review 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.

What is an insurance utilization review?

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.

What are the key skills and qualifications needed to thrive in insurance utilization review?

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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are popular job titles related to Insurance Utilization Review jobs in Miami, FL?

For Insurance Utilization Review jobs in Miami, FL, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Miami, FL look for?

The top searched job categories for Insurance Utilization Review jobs in Miami, FL are:

What cities near Miami, FL are hiring for Insurance Utilization Review jobs?

Cities near Miami, FL with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Miami, FL as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, and 5% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $84,116 per year, or $40.4 per hour.

Care Management Discharge Plan Coordinator, Case Management, FT, 8A-4:30P

Baptist Health South Florida

South Miami, FL • On-site

$18.87 - $23.96/hr

Full-time

Re-posted 21 days ago

Baptist Health South Florida rating

8.1

Company rating: 8.1 out of 10

Based on 99 frontline employees who took The Breakroom Quiz

1st of 24 rated health and beauty retailers

Job description

Coordinates and manages a wide range of complex and high volume patient referrals to ensure continuity of post Discharge Care, as part of the Care Management Team. This position has a significant impact on patient throughput, length of stay, patient safety and patient satisfaction. Specific duties include frequent interactions with care managers, patients, payers, and community care providers, data entry and analysis related to insurance coverage and availability of resources, coordination of post discharge services including home health care, durable medical equipment, nursing homes, hospital transfers, transportation and services for the indigent population. Conducts post Discharge Follow-up Calls to assure post discharge services are being rendered and problem solves accordingly by contacting service providers to effect patient safety. Elicits feedback from patient/family regarding the services they received and communicates any reported dissatisfactions immediately to effect service recovery.Estimated pay range for this position is $18.87 - $23.96 / hour depending on experience.Degrees:
  • High School,Cert,GED,Trn,Exper.
Additional Qualifications:
  • Associate Degree preferred ; Prior experience in a healthcare setting ; prior additional education experience in discharge planning, billing utilization review, financial counseling or registration preferred.
  • Ability to develop and maintain good working relationships.
  • Ability to work in a high volume environment while maintaining high quality standards.
  • Strong analytical and problem solving skills required.
  • Excellent written legible and verbal English communication skills required.
  • Ability to manage workload, set priorities, and operate with minimal direct supervision.
  • Ability to handle moderately to highly complex problems or issues in standard and sometimes emergent situations.
  • Secretarial experience, excellent communication skills; excellent customer service skills; computer skills with Microsoft Word; Minimum typing speed of 30 WPM required.
Minimum Required Experience: 1 Year

What Baptist Health South Florida employees say

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Benefits

Hours and flexibility

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About Baptist Health South Florida

Sourced by ZipRecruiter

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 27,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Miami, FL, US

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