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Intern Insurance Utilization Review Jobs in Boca Raton, FL

Genex

Telephonic Case Manager

Boca Raton, FL · On-site

... utilization review process including, but not limited to, Third-Party Payers, Insurance Companies and Providers. • Perform Utilization Review activities prospectively, concurrently or ...

genex

Telephonic Case Manager

Boca Raton, FL · On-site

Interface with external agencies/representatives relative to the utilization review process including, but not limited to, Third-Party Payers, Insurance Companies and Providers. Perform Utilization ...

genex

Telephonic Case Manager

Boca Raton, FL · On-site

Interface with external agencies/representatives relative to the utilization review process including, but not limited to, Third-Party Payers, Insurance Companies and Providers. Perform Utilization ...

Oak St. Health

Grad Pharmacist

Palm Springs, FL · On-site

$15 - $18.50/hr

Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

Oak St. Health

Grad Pharmacist

Riviera Beach, FL · On-site

$16.25 - $20.25/hr

Graduate Pharmacy Intern You've invested a lot of time and energy in your education. Now you want ... quality assurance drug utilization review (DUR), pharmacy professional standards such as ...

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All JobsIntern Insurance Utilization Review JobsIntern Insurance Utilization Review Jobs in Boca Raton, FL

Intern Insurance Utilization Review information

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How much do intern insurance utilization review jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for intern insurance utilization review in Boca Raton, FL is $15.92, according to ZipRecruiter salary data. Most workers in this role earn between $13.70 and $17.79 per hour, depending on experience, location, and employer.

What does an intern insurance utilization review do?

An Intern Insurance Utilization Review assists with evaluating medical records and insurance claims to ensure that healthcare services are medically necessary and covered by insurance policies. They work under supervision to review documentation, communicate with healthcare providers, and help determine if treatments meet established guidelines. This role provides valuable exposure to the insurance and healthcare industries, helping interns learn about claims processing, policy compliance, and the importance of cost-effective care.

What skills and qualifications are needed to thrive as an intern insurance utilization review?

To thrive as an Intern in Insurance Utilization Review, you typically need a background in healthcare administration or a related field, along with strong analytical and organizational skills. Familiarity with electronic health records (EHRs), insurance databases, and claims processing systems is often required. Attention to detail, effective communication, and the ability to collaborate with both clinical and administrative teams are essential soft skills. These competencies ensure accurate review of insurance claims, compliance with regulations, and efficient coordination between healthcare providers and insurers.

What is the difference between Intern Insurance Utilization Review vs Insurance Claims Processor?

AspectIntern Insurance Utilization ReviewInsurance Claims Processor
CredentialsTypically pursuing or holding a relevant degree (e.g., health administration, nursing)High school diploma or equivalent; some roles may require insurance or claims processing certifications
Work EnvironmentHealthcare settings, insurance companies, or administrative officesInsurance companies, healthcare providers, or claims processing centers
Primary ResponsibilitiesAssisting in reviewing medical necessity, supporting utilization review processesProcessing and reviewing insurance claims for accuracy and completeness

Intern Insurance Utilization Review focuses on evaluating medical necessity and supporting healthcare decision-making, often involving review of patient records. Insurance Claims Processors handle the administrative task of reviewing and processing insurance claims for payment. While both roles involve insurance and healthcare, utilization review emphasizes clinical assessment, whereas claims processing centers on administrative claim management.

How do I get into an intern insurance utilization review?

To become an intern in insurance utilization review, candidates typically need to be enrolled in or have recently completed a relevant healthcare or insurance-related program, such as health administration or nursing. Gaining knowledge of medical terminology, insurance policies, and utilization review processes, along with strong analytical skills, is important; some positions may require certification or training in healthcare quality or case management. Internships are often offered through insurance companies, healthcare organizations, or hospitals and may require applying through their career portals or internship programs.

Is utilization review a stressful job?

Utilization review as an intern involves evaluating insurance claims and determining appropriate care, which can be demanding due to strict deadlines and the need for accuracy. The role requires attention to detail and knowledge of insurance policies, but stress levels vary depending on workload and individual coping skills.
Intern Insurance Utilization Review jobs near you

Utilization Review Nurse

Cooper City, FL

Health Business Solutions LLC
Health Care and Social Assistance • 51 - 200 employees
Learn more about Health Business Solutions LLCexternal

Full-time

Re-posted 7 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.