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Senior Rn Utilization Review Nurse Jobs in Boca Raton, FL

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Senior Rn Utilization Review Nurse information

See Boca Raton, FL salary details

$20

$40

$65

How much do senior rn utilization review nurse jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for senior rn utilization review nurse in Boca Raton, FL is $40.12, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.06 per hour, depending on experience, location, and employer.

What is the difference between Senior Rn Utilization Review Nurse vs Rn Case Manager?

AspectSenior Rn Utilization Review NurseRn Case Manager
CertificationsRN license, possibly UR or case management certificationRN license, often case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and utilization of servicesCoordinating patient care and discharge planning
Common UsageUsed in insurance and healthcare review settingsUsed in patient care coordination and discharge planning

The Senior Rn Utilization Review Nurse primarily focuses on evaluating the necessity and appropriateness of healthcare services, often working within insurance companies or healthcare organizations. In contrast, Rn Case Managers concentrate on coordinating patient care, discharge planning, and ensuring smooth healthcare delivery. Both roles require RN licensure and relevant certifications, but their daily responsibilities and work environments differ slightly.

What does a Senior RN Utilization Review Nurse do?

A Senior RN Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that treatments are cost-effective and meet established standards of care. Additionally, they often mentor junior staff, participate in policy development, and help optimize resource utilization within healthcare organizations. Their work supports quality patient care while managing healthcare costs.

What are some typical challenges faced by a Senior RN Utilization Review Nurse when coordinating with multidisciplinary teams?

Senior RN Utilization Review Nurses often collaborate with physicians, case managers, and insurance representatives to ensure patients receive appropriate, cost-effective care. A common challenge is balancing clinical guidelines with payer requirements, which can sometimes lead to differing opinions on the necessity of certain treatments or services. Effective communication, strong negotiation skills, and up-to-date knowledge of regulatory standards are essential to navigate these situations successfully. Being proactive and maintaining strong professional relationships helps facilitate smoother approvals and promotes patient-centered care.

What are the key skills and qualifications needed to thrive as a Senior RN Utilization Review Nurse, and why are they important?

To thrive as a Senior RN Utilization Review Nurse, you need a strong clinical nursing background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and certifications like CCM (Certified Case Manager) or URAC are highly beneficial. Exceptional critical thinking, attention to detail, and effective communication skills distinguish top performers in this role. These skills ensure accurate case evaluations, compliance with regulations, and optimized patient care while controlling healthcare costs.
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Senior Rn Utilization Review Nurse jobs near you

Oncology Nurse Advocate

RN Cancer Guides

Fort Lauderdale, FL

Contractor

Re-posted yesterday

Job description

Company Description

RN Cancer Guides' mission is to provide compassionate professional oncology nursing guidance to patients and their families through their cancer journey.  Based out of Tampa, FL, we are a small, fast-growing team of Oncology Nurses who assist cancer patients and their caregivers while they attempt to navigate the complex healthcare system.

Job Description

Work directly with Ft. Lauderdale/Miami clients to help them coordinate their cancer care and navigate the healthcare system. Committed and passionate about changing the way cancer patients and their caregivers experience cancer care by empowering them to make informed decisions and give them peace of mind knowing that a qualified oncology nurse is on their side helping to guide them through their journey with cancer.

Essential Responsibilities

  • Interview patients and their loved ones to identify issues relating to their medical care
  • Assist clients or their caregivers with developing scope of services with clearly stated goals and objectives
  • Assist clients with general healthcare coordination across multiple providers and facilities
  • Act as a liaison between clients and their healthcare team, and serve as their advocate to ensure clients are well-informed and active participants in their own healthcare
  • Help clients understand their medical conditions and treatment options
  • Develop and implement action plans to help clients reach their goals
  • Provide clients with well-researched healthcare options (doctors, facilities, treatment, clinical trials, and other community services and resources available)
  • Coordinate appointments, care, including compiling medical records for upcoming medical appointments
  • Maintain HIPAA standards regarding confidentiality of highly sensitive patient information and perform all activities with discretion
Qualifications

Education: Graduate from accredited nursing school 

Experience: At least 5 years of clinical experience as a Registered Nurse in Oncology. Experience in case management, discharge planning, eligibility or membership, utilization management.

Certifications: Oncology Certified Nurse (OCN)

Licensure: Current Florida RN or NP

Preferred: BSN or MSN, Case Management Certification, utilization review experience


Knowledge/Skills/Abilities

  • Strong computer skills, including Microsoft Office
  • Must be possess strong customer service skills
  • Must have excellent interpersonal, verbal and written communication skills, and compassion
  • Familiarity with online research tools
Additional Information

All your information will be kept confidential according to EEO guidelines.

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