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Utilization Case Manager Jobs in Florida (NOW HIRING)

Halifax Health

Nurse Case Manager

Daytona Beach, FL · On-site

The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...

Acadia Healthcare

Case Manager

Navarre, FL · On-site

$18.50 - $23.75/hr

... utilization of resources, service delivery, and compliance with external agencies and referral ... experience in case management and/or utilization review preferred. LICENSES/DESIGNATIONS ...

Gateway Foundation

CASE MANAGER

Lakeland, FL · On-site

$46K/yr

... to ensure maximum utilization of available resources and services to clients, in order to ... Certified Behavioral Health Case Manager (CBHCM) preferred * 2 years case management experience

Halifax Health

Nurse Case Manager

Daytona Beach, FL

The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...

Halifax Health

Nurse Case Manager

Daytona Beach, FL · On-site

The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...

Gateway Foundation Inc

CASE MANAGER

Lakeland, FL

$46K/yr

... to ensure maximum utilization of available resources and services to clients, in order to ... Certified Behavioral Health Case Manager (CBHCM) preferred * 2 years case management experience

Gateway Foundation

CASE MANAGER

Lakeland, FL

$46K/yr

... to ensure maximum utilization of available resources and services to clients, in order to ... Certified Behavioral Health Case Manager (CBHCM) preferred * 2 years case management experience

Encompass Health

Case Manager

Vero Beach, FL

$17.50 - $22.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health Corporation

Case Manager

Vero Beach, FL · On-site

$17.75 - $22.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications • License or ...

Encompass Health

Case Manager

Vero Beach, FL

$17.50 - $22.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Saint Petersburg, FL · On-site

$19 - $24.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Sunrise, FL · On-site

$19 - $24.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Altamonte Springs, FL · On-site

$18.75 - $24/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

All Med Search

Case Manager RN

Tallahassee, FL

$31.94 - $43.92/hr

The RN Case Manager performs utilization management reviews and communicates findings to third-party payors, evaluates observation patients for status appropriateness, and escalates medical necessity ...

Encompass Health

Case Manager

Fort Myers, FL · On-site

$18.75 - $24/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Brooksville, FL · On-site

$16.50 - $21.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

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Showing results 21-40

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Florida

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Florida? For Utilization Case Manager jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Florida look for? The top searched job categories for Utilization Case Manager jobs in Florida are:
What cities in Florida are hiring for Utilization Case Manager jobs? Cities in Florida with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Florida as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

Nurse Case Manager

Halifax Health

Daytona Beach, FL • On-site

Other

Re-posted 18 days ago

Halifax Health rating

6.0

Company rating: 6.0 out of 10

Based on 66 frontline employees who took The Breakroom Quiz

749th of 887 rated healthcare providers

Job description

Day (United States of America)
Nurse Case Manager
The purpose of the Nurse Case Manager is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement in needed (e.g., day to day workflow, education, process improvements, patient satisfaction).
- Completion of an accredited LPN or RN nursing program
- Three years acute care experience in a hospital setting; one year as a utilization review nurse preferred
- Licensed Nurse in the State of Florida
- Demonstrates effective interpersonal and communication skills
- Demonstrates flexibility via an ability to adapt to changing priorities
- Demonstrates good customer relations
- Ability to prioritize assignments and effective time-management skills
- Basic knowledge of clinical and psychosocial aspects of patient care
- Must be detail oriented, flexible, and committed to patient advocacy
- Demonstrates skills in planning, organizing, and managing multiple functions and complex processes
- Excellent verbal and written communication skills required
- Knowledge of basic computer software programs
- Knowledge of area community resources and referrals

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