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Manager Utilization Management Jobs in Riverview, FL

Elevance Health

Utilization Management Rep III

Tampa, FL · On-site

Utilization Management Rep III Afterhours Utilization Management Representative III Location : This ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...

NTT DATA Services

BPO Senior Manager

Tampa, FL · Remote

$93K/yr

Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA standards, Medicaid regulations, and medical necessity review requirements. * Demonstrated expertise ...

Posted today

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Detail-oriented with strong organizational skills to manage multiple cases efficiently.

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Riverview, FL

Manager Utilization Management information

See Riverview, FL salary details

$34.8K

$81.2K

$149.4K

How much do manager utilization management jobs pay per year?

As of Aug 28, 2026, the average yearly pay for manager utilization management in Riverview, FL is $81,174.00, according to ZipRecruiter salary data. Most workers in this role earn between $53,100.00 and $97,700.00 per year, depending on experience, location, and employer.

What does a manager 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 key skills and qualifications needed to thrive as a manager utilization management?

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 are some common challenges faced by a manager 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 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 the most commonly searched types of Utilization Management jobs in Riverview, FL?

The most popular types of Utilization Management jobs in Riverview, FL are:

What are popular job titles related to Manager Utilization Management jobs in Riverview, FL?

For Manager Utilization Management jobs in Riverview, FL, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Riverview, FL look for?

The top searched job categories for Manager Utilization Management jobs in Riverview, FL are:

What cities near Riverview, FL are hiring for Manager Utilization Management jobs?

Cities near Riverview, FL with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Riverview, FL as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $81,174 per year, or $39 per hour.

Registered Nurse - Utilization Manager

Giacare Inc

Tampa, FL • On-site

Full-time

Posted 20 days ago

Job description

GiaCare Inc. is accepting applications from experienced Utilization Managers (RN) for a future opportunity supporting MacDill Air Force Base at Tampa, Florida.

This position is being recruited in anticipation of contract award. Qualified candidates will be considered for employment upon contract award.

About the Opportunity

Join the 6 MDG healthcare team as a Utilization Manager RN, applying clinical review criteria to support appropriate, efficient use of care for active-duty service members, retirees, and their families.

Schedule
  • Full-Time
  • Monday–Friday
  • 9-hour shifts, duty hours 0730–1630
  • 60-minute unpaid lunch
  • Not to exceed 40 hours per week
  • No on-call
Responsibilities
  • Conduct utilization review and medical necessity determinations using established clinical criteria
  • Review admissions, continued stay, and level-of-care decisions in coordination with providers
  • Support the facility's utilization management program and related reporting requirements
  • Collaborate with case management, providers, and MTF leadership on utilization trends
  • Accurately and timely report data through required government reporting systems
  • Document review activity within the electronic medical record
Minimum Qualifications
  • U.S. Citizen, U.S. national, lawful permanent resident, or individual otherwise authorized to work in the United States
  • Associate's Degree of Nursing
  • Current, full, active, unrestricted Registered Nurse license in any U.S. state, territory, or the District of Columbia
  • Prior clinical nursing experience; utilization review/utilization management experience strongly preferred
  • Current Basic Life Support (BLS) certification (or willing to obtain)
  • Able to pass a Tier 1 (or higher) background investigation for facility and network access
  • 3 years in last 4 years as a registered nurse in utilization management
Preferred Qualifications
  • Experience applying InterQual, MCG, or comparable utilization review criteria
  • Experience in utilization management within a military treatment facility or managed-care setting
  • Strong analytical, documentation, and cross-team communication skills
Why GiaCare?

GiaCare is dedicated to supporting our nation's military by connecting exceptional healthcare professionals with military treatment facilities throughout the United States. Our team is committed to delivering high-quality patient care while providing meaningful career opportunities for healthcare professionals.

This position is being recruited in anticipation of contract award. Employment is contingent upon contract award and successful completion of all pre-employment requirements.



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