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Utilization Care Manager Jobs in Florida (NOW HIRING)

Insight Global

Care Manager

Apollo Beach, FL · On-site

$85K - $90K/yr

... appropriate utilization of healthcare resources. The ideal candidate is clinically strong ... care management efforts in partnership with PCPs and the care team • Identify and follow ...

Insight Global

Care Manager

Apollo Beach, FL · On-site

$75K - $80K/yr

... appropriate utilization of healthcare resources. The ideal candidate is clinically strong ... care management efforts in partnership with PCPs and the care team • Identify and follow ...

Lee Health

Case Manager RN - Emergency Dept

Fort Myers, FL · On-site

$31.78 - $42.90/hr

Supplemental benefits (pet insurance, legal insurance, etc) Summary Emergency Department Utilization Care Managers perform utilization management functions to ensure medical necessity and the ...

Independent Living Systems

MMA Care Manager

Miami, FL · On-site

The Care Manager acts as a liaison between member, healthcare providers, and insurance entities to optimize care delivery and resource utilization. By monitoring member progress and addressing ...

InnovaCare

Registered Nurse Care Manager

Lakeland, FL · On-site

Inpatient Care Managers review medical records to ensure appropriate utilization and that patients' needs are met for the discharge plan. They collaborate with the inpatient regional medical director ...

InnovaCare

Registered Nurse Care Manager

Lakeland, FL · Hybrid

Inpatient Care Managers review medical records to ensure appropriate utilization and that patients' needs are met for the discharge plan. They collaborate with the inpatient regional medical director ...

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Utilization Care Manager information

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

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

How does a Utilization Care Manager typically collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are Utilization Care Managers?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

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

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What are popular job titles related to Utilization Care Manager jobs in Florida? For Utilization Care Manager jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Florida look for? The top searched job categories for Utilization Care Manager jobs in Florida are:
What cities in Florida are hiring for Utilization Care Manager jobs? Cities in Florida with the most Utilization Care Manager job openings:
Utilization Care Manager jobs near you
Care Manager

Care Manager

Insight Global

Apollo Beach, FL • On-site

$85K - $90K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 15 days ago

Job description

JOB DESCRIPTION

Insight Global is seeking a Care Manager (RN) for a top healthcare services client. This individual will lead care coordination efforts for high‐risk patients, ensuring smooth transitions across care settings and appropriate utilization of healthcare resources.
The ideal candidate is clinically strong, patient‐focused, and comfortable working both onsite and telephonically while partnering closely with providers and multidisciplinary care teams to improve outcomes and patient experience.
Day‐to‐Day:
• Ensure continuity of care across inpatient and outpatient settings
• Lead care management efforts in partnership with PCPs and the care team
• Identify and follow high‐risk patients across acute, SNF, custodial, and ambulatory settings
• Coordinate treatment plans and appropriate utilization of resources
• Conduct patient and family education related to care plans and transitions
• Support discharge planning, follow‐up appointments, home health, and community resources
• Use disease management protocols and care pathways to optimize outcomes
• Perform telephonic triage and motivational interviewing to support self‐management
• Document care activities in the EHR and care management systems
• Collaborate closely with physicians, hospitalists, and extended care facilities
• Travel locally or provide remote coverage as business needs require


REQUIRED SKILLS AND EXPERIENCE

• Active Florida RN license
• Graduation from an accredited school of nursing
• BLS / CPR certification (AHA or Red Cross; or ability to obtain within 90 days)
• Prior experience in acute clinical care or equivalent
• Experience in care management, utilization review, or discharge planning
• Strong knowledge of HIPAA and patient confidentiality
• Ability to work collaboratively with providers and multidisciplinary care teams
• Strong patient communication, organization, and multitasking skills


NICE TO HAVE SKILLS AND EXPERIENCE

• Experience in an acute care setting
• Prior HMO or managed care experience
• Experience with Transitions of Care programs
• Experience working with high‐risk patient populations