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Utilization Care Manager Jobs in Florida (NOW HIRING)

Care Manager

Sarasota, FL · On-site

$68K - $80K/yr

Gaps-in-Care & Utilization Management: Proactively identify and close clinical and documentation gaps to support Value-Based Care (VBC) contracts, including ACO initiatives. Take accountability for ...

Gaps-in-Care & Utilization Management: Proactively identify and close clinical and documentation gaps to support Value-Based Care (VBC) contracts, including ACO initiatives. Take accountability for ...

CC017410 Care Management Summary: Position Responsibilities * Proactively identifies patients ... Conducts/documents utilization reviews in a complete and timely manner * Utilizes InterQual ...

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 ...

Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...

Utilization Management supporting medical necessity and denial prevention * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction * Care ...

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Utilization Care Manager information

How does a utilization care manager 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 is a utilization care manager?

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 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.

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 cities in Florida are hiring for Utilization Care Manager jobs? Cities in Florida with the most Utilization Care Manager job openings:

RN Manager of Care Management

Community Health Systems

Naples, FL • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago


Community Health Systems rating

6.9

Company rating: 6.9 out of 10

Based on 275 frontline employees who took The Breakroom Quiz

453rd of 887 rated healthcare providers


Job description

Why You’ll Love Working Here

  • Competitive Compensation – Salary and benefits package designed to reward your expertise, leadership, and contributions.

  • Comprehensive Health Coverage – Medical, dental, vision, and life insurance options to support you and your family.

  • Future Security – 401(k) retirement plan with employer matching to help you build long-term financial stability.

  • Generous Paid Time Off – Paid Time Off (PTO) and Extended Illness Bank (EIB) to support work-life balance and personal well-being.

  • Career Growth Opportunities – Professional development, leadership training, and advancement opportunities across our organization.

  • Recognition & Reward Programs – We celebrate employee achievements and contributions to our success.

  • Exclusive Employee Discounts & Perks – Access to special savings and benefits designed for our team members.

Job Summary

The Manager, Care Management is responsible for the planning, coordination, and oversight of care management services, including utilization review, discharge planning, and transitions of care. The role ensures care is appropriate, timely, cost-effective, and aligned with patient needs and organizational goals. The Manager leads the daily operations of the Care Management department, supervises staff, and collaborates with physicians, nurses, payors, and other healthcare team members to facilitate care coordination, improve outcomes, and support effective resource utilization.

Essential Functions

  • Manages the daily operations of the Care Management department, ensuring services are delivered efficiently, effectively, and in compliance with organizational standards.

  • Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness.

  • Directs and prioritizes workload based on patient length of stay, diagnosis-related groups (DRGs), charges, reimbursement, and other risk factors.

  • Evaluates patients through chart review, interviews with providers and staff, and patient assessments to support care planning and transitions.

  • Collaborates with physicians, nurses, ancillary services, and payors to streamline care, resolve barriers, and ensure timely discharge planning.

  • Monitors observation stays and ensures compliance with regulatory requirements, timely admission, or discharge decisions.

  • Prepares and delivers reports on utilization, care management performance, and variance from expected outcomes to facility and organizational leadership.

  • Performs other duties as assigned.

  • Maintains regular and reliable attendance.

  • Complies with all policies and standards.

Leadership Responsibilities

  • Supervision and Staff Management

  • Provides leadership, mentorship and professional development opportunities for departmental staff.

  • Schedules employees to ensure effective use of resources. Consults with Director on staffing issues.

  • Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.

  • Strategic Planning and Financial Oversight

  • Develops and manages departmental budget ensuring cost effective operations while maintaining high quality service.

  • Monitors expenditures, ensuring cost-effective delivery of services.

  • Evaluates and implements new technologies to enhance operational efficiency.

  • Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.

  • Quality Assurance and Regulatory Compliance

  • Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.

  • Participates in audits, inspections and accreditation processes as applicable.

  • Follows established quality control practices to ensure accuracy, consistency and safety.

  • Collaboration and Communication

  • Works closely with leadership teams to coordinate and improve service delivery.

  • Stays up-to-date with industry advancements, new technologies, and regulatory changes.

  • Staff Responsibilities

  • May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job.

Qualifications

  • Bachelor's Degree in relevant field required or

  • Four (4) plus years of direct experience in lieu of a Bachelor's degree required

  • Master's Degree preferred

  • 2-4 years of experience in closely related field with Bachelor's degree required

  • 2-4 years of previous leadership experience preferred

Knowledge, Skills and Abilities

  • Strong leadership, organizational, and communication skills.

  • Ability to collaborate with interdisciplinary teams and manage cross-functional relationships.

  • Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement.

  • Communicate effectively with leadership, team members, and stakeholders.

  • Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.

  • Problem-solving and critical thinking skills.

  • In depth knowledge of industry best practices and regulatory compliance (if applicable).

  • Strong organizational and time management skills.

  • Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools.

Licenses and Certifications

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required or

  • LCSW- License Clinical Social Worker required or

  • LMSW - Licensed Medical Social Worker - State Licensure required

Why Work at Physicians Regional-Collier?

At Physicians Regional-Collier , we’re more than healthcare providers, we’re a team dedicated to compassionate care and community wellness. Join us for a supportive work environment, opportunities for professional growth, and the chance to make a real difference in the lives of our patients every day. Your skills, your passion, and your commitment matter here.

T his position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.

INDLEAD

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.


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