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Manager Optum Utilization Review Jobs in Florida

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Genex Services

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

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Manager Optum Utilization Review information

What does a manager Optum Utilization Review do?

A Manager of Optum Utilization Review oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that all reviews comply with regulatory standards, company policies, and clinical guidelines. Managers also collaborate with healthcare providers, monitor team performance, and help implement process improvements to optimize patient outcomes and resource use. Their role is vital in balancing quality patient care with cost-effective service delivery.

How does a manager Optum Utilization Review typically collaborate with clinical and non-clinical teams to ensure effective case management?

As a Manager in Optum Utilization Review, you will regularly coordinate with clinical teams such as nurses, physicians, and case managers to review patient cases for medical necessity and compliance with policies. You’ll also work closely with non-clinical staff, including data analysts and administrative professionals, to streamline workflows and support accurate documentation. Effective collaboration ensures timely decision-making, helps resolve escalated cases, and supports continuous quality improvement initiatives. This role often requires strong communication and leadership skills to align multidisciplinary teams and achieve organizational goals.

What are the key skills and qualifications needed to thrive as a manager Optum Utilization Review, and why are they important?

To thrive as a Manager, Optum Utilization Review, you need a background in healthcare management, clinical expertise (often as an RN or related field), and experience with utilization management processes. Familiarity with utilization review software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) or URAC accreditation is typically required. Strong leadership, analytical thinking, and effective communication skills help you guide teams and collaborate with providers and payers. These competencies are crucial for ensuring compliance, optimizing patient care, and achieving organizational goals in a complex healthcare environment.

What is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?

AspectManager Optum Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications in case management or utilization reviewRegistered Nurse (RN) license, certifications in case management or utilization review
Work EnvironmentSupervises teams, manages review processes, collaborates with healthcare providersConducts patient reviews, assesses medical necessity, documents findings
Employer & Industry UsageCommon in health insurance companies, managed care organizations, healthcare providersPrimarily in hospitals, insurance companies, healthcare organizations

The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.

What are the most commonly searched types of Optum Utilization Review jobs in Florida?

The most popular types of Optum Utilization Review jobs in Florida are:

What are popular job titles related to Manager Optum Utilization Review jobs in Florida?

For Manager Optum Utilization Review jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in Florida look for?

The top searched job categories for Manager Optum Utilization Review jobs in Florida are:

What cities in Florida are hiring for Manager Optum Utilization Review jobs?

Cities in Florida with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Florida as of August 2026, with employment types broken down into 2% As Needed, 88% Full Time, 6% Part Time, 2% Temporary, and 2% Contract. Highlights an 89% In-person, 2% Hybrid, and 9% Remote job distribution.

Utilization Review/Outpatient Care RN

Healthcare Support Staffing

Tampa, FL • On-site

$28 - $32/hr

Full-time

Re-posted 13 days ago

Job description

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Job Title: Utilization Review/Outpatient Care RN

Are you an experienced Registered Nurse with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!


Position Summary:

As the Utilization Review/Outpatient Care RN, you would be responsible for reviewing and collecting medical information in order to determine medical necessity of services requested.


Hours for this Position: Monday-Friday daytime hours (40 hours/week)


Advantages of this Opportunity:

  • Pay $28-$32 per hour, negotiable based on experience
  • Work for a prominent Healthcare company who pride themselves on partnership, integrity, teamwork, and accountability
  • Be a part of a team who serves the full spectrum of member needs
  • Weekly deposit options
  • Great benefits offered


More Insight of Daily Responsibilities: 

  • Ensures that services provided to eligible members are within benefit plan 
  • Initiates and continues direct communication with health care providers involved with the care of the member 
  • Identifies appropriate clinical settings for services being requested
  • Identifies and refers cases appropriate for case management
  • Identifies potential quality of care issues and refers to Quality Department
  • Determines appropriate utilization management of services requested
Qualifications

What We Look For:

  • Clear and active RN license in state of FL
  • 2+ years of acute clinical/surgical position
  • Recent experience with utilization management
Additional Information

Interested in being considered in this position?

TAKE THE NEXT STEP! Click the green I'M INTERESTED button to send me your resume.

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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