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Manager Utilization Management Jobs in Florida (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL

The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...

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Manager Utilization Management information

See Florida salary details

$29.1K

$68K

$125.2K

How much do manager utilization management jobs pay per year?

As of Jul 6, 2026, the average yearly pay for manager utilization management in Florida is $68,012.00, according to ZipRecruiter salary data. Most workers in this role earn between $44,500.00 and $81,800.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Florida? The most popular types of Utilization Management jobs in Florida are:
What are popular job titles related to Manager Utilization Management jobs in Florida? For Manager Utilization Management jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Florida look for? The top searched job categories for Manager Utilization Management jobs in Florida are:
What cities in Florida are hiring for Manager Utilization Management jobs? Cities in Florida with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
RN, Utilization Management | Utilization Management

RN, Utilization Management | Utilization Management

UF Health

The Villages, FL • On-site

Full-time

Posted 12 days ago

Job description

Overview
Join an onsite clinical team focused on ensuring the right care at the right time for every patient.
Work Style: Onsite
Location: The Villages, FL
FTE: Full-Time (1.0 FTE)
Schedule: Monday - Friday (occasional weekends required)
Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.
Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement.
Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.
Responsibilities
Key Responsibilities
  • Evaluates patient medical records to ensure the necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers to ensure compliance with utilization management guidelines.
  • Supports the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
  • Communicates authorization decisions clearly and supports timely discharge planning.
  • Analyzes utilization data to identify trends and opportunities to improve care coordination.
  • Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications
Education & Experience:
Registered Nurse (RN) with a current Florida license required.
  • Three (3) years of critical care nursing experience, or
  • Five (5) years of medical-surgical nursing experience, or
  • Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications
  • Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
  • Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
  • Experience evaluating medical necessity and optimizing treatment plans.
  • Excellent communication skills with the ability to clearly convey authorization decisions.
  • Ability to analyze utilization data and support effective care coordination.
  • Strong organizational skills with the ability to manage multiple priorities simultaneously.
  • Ability to work independently and collaboratively with multidisciplinary teams.
  • Strong attention to detail and innovative problem-solving skills.
  • Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation:
Employees in this position will not operate vehicles for an assigned business purpose.
Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.
Licensure/Certification/Registration:
  • Registered Nurse (RN) with a current Florida license required.

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