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

Oscar Health

Sr. Quality of Care Review Nurse

Miami, FL · Remote

$83K - $109K/yr

We're hiring a Sr. Quality of Care Review Nurse to join our Quality team. Oscar is the first health ... insurance experience a plus. * Experience with NCQA accreditation standards for utilization ...

Solaris HealthCare Lake City

RN Unit Manager

Pompano Beach, FL · On-site

$38.25 - $50.75/hr

Affordable Health, Dental & Vision Insurance (family options included) Advanced Pay -get paid when ... and utilization review activities. * Participates in clinical risk identification, strategy ...

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 ...

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

Insurance Utilization Review information

See Miami, FL salary details

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$65

How much do insurance utilization review jobs pay per hour?

As of Aug 13, 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 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 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 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 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, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $84,116 per year, or $40.4 per hour.

Clinical Reviewer Nurse

Integrated Home

Hollywood, FL • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 25 days ago

Job description

Who we are:
Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System in the home setting, offering Durable Medical Equipment (DME), Respiratory, Home Health, and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to meet the needs of our patients with compassion, expertise, and excellence.
For more than 30 years, IHCS has been dedicated to improving lives by delivering the highest quality in-home care services. As a trusted market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services, we proudly serve more than 2 million lives across the United States and the Commonwealth of Puerto Rico. Our integrated care model is trusted by leading Managed Care Organizations (MCOs), physicians, and healthcare partners because of our commitment to exceptional patient outcomes and coordinated care.
At IHCS, our patients are at the heart of everything we do. We believe in creating a culture built on compassion, integrity, collaboration, and innovation. Every team member plays a vital role in fulfilling our mission of enhancing the quality of life for those we serve through Exceptional Customer Service, Proven Outcomes, and Seamless Care.
If you are passionate about making a meaningful impact, thrive in a collaborative environment, and are committed to excellence, we invite you to join our growing team. Together, we can continue transforming home healthcare while making a difference in the lives of our patients and the communities we serve.
Join IHCS where our patients are #1, and our people make the difference. Apply today!
Offering a competitive compensation package, including but not limited to;
  • Medical, Vision, Dental, Short- and Long-term insurance
  • 6+ Days of Holidays Pay
  • PTO
  • Employer paid life insurance
  • 401K with employer contribution
  • Wellness program with reward incentives
  • Employee recognition and reward programs
  • Comprehensive paid training program
What will you be doing:
As a Utilization Management Nurse, you will ensure that home health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare.
  • Concurrent review of patient’s clinical information for efficiency
  • Ongoing review of precertification requests for medical necessity
  • Coordinates patient care needs with a multi-disciplinary healthcare team
  • Maintain accurate records of all patient related interactions
  • Ability to stay organized and interact well with others in any situation
  • Provide updates to Manager of Utilization Management for review
What will you need to succeed:
  • State licensure as a LPN or RN
  • Minimum 2 years of prior experience in Utilization Management
  • Strong knowledge of word processing and spreadsheet computer programs
  • Utilization Management or Case Management certification preferred

Join our team as we strive for excellence through teamwork, where our patients are #1!
IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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