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Utilization Management Non Clinical Jobs in Florida

Solis Health Plans

Utilization Management Nurse

Miami, FL · On-site

$60K - $70K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine ... Utilization Management nurse in a managed care payer preferred. * One year experience as a case ...

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Utilization Management Non Clinical information

What is the difference between Utilization Management Non Clinical vs Utilization Review Nurse?

AspectUtilization Management Non ClinicalUtilization Review Nurse
CredentialsCertifications like CCM, RN (optional), but primarily non-clinical certificationsRN license, certifications such as CCM or CUC
Work EnvironmentOffice-based, administrative setting, telecommuting optionsClinical settings, hospitals, or insurance companies, often with direct patient or provider interaction
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentUnderstanding non-clinical roles in utilization managementClinical review roles involving direct patient care assessment

Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.

Is utilization management a hard job?

Utilization Management Non Clinical roles involve reviewing healthcare services to ensure appropriate use of resources, which can be challenging due to the need for attention to detail, understanding of medical policies, and decision-making under time constraints. The job requires strong analytical skills, knowledge of healthcare guidelines, and often involves working with electronic health records and insurance policies.

What are popular job titles related to Utilization Management Non Clinical jobs in Florida?

For Utilization Management Non Clinical jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Utilization Management Non Clinical jobs in Florida look for?

The top searched job categories for Utilization Management Non Clinical jobs in Florida are:

What cities in Florida are hiring for Utilization Management Non Clinical jobs?

Cities in Florida with the most Utilization Management Non Clinical job openings:

Utilization Management Non Clinical jobs near you
Infographic showing various Utilization Management Non Clinical job openings in Florida as of August 2026, with employment types broken down into 89% Full Time, and 11% Nights. Highlights an 78% In-person, 11% Hybrid, and 11% Remote job distribution.

RN, Utilization Management | Utilization Management

UF Health

The Villages, FL • On-site

Other

Re-posted 19 days ago

Job description

Clinical Team Member

Join an onsite clinical team focused on ensuring the right care at the right time for every patient.

Work Style: Onsite Location: The Villages, FL FTE: Full-Time (1.0 FTE) Schedule: Monday – Friday (occasional weekends required)

Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.

Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement.

Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.

Key Responsibilities
  • Evaluates patient medical records to ensure the necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers to ensure compliance with utilization management guidelines.
  • Supports the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
  • Communicates authorization decisions clearly and supports timely discharge planning.
  • Analyzes utilization data to identify trends and opportunities to improve care coordination.
  • Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.
Qualifications

Education & Experience:

Registered Nurse (RN) with a current Florida license required.

  • Three (3) years of critical care nursing experience, or
  • Five (5) years of medical-surgical nursing experience, or
  • Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications

  • Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
  • Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
  • Experience evaluating medical necessity and optimizing treatment plans.
  • Excellent communication skills with the ability to clearly convey authorization decisions.
  • Ability to analyze utilization data and support effective care coordination.
  • Strong organizational skills with the ability to manage multiple priorities simultaneously.
  • Ability to work independently and collaboratively with multidisciplinary teams.
  • Strong attention to detail and innovative problem-solving skills.
  • Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation: Employees in this position will not operate vehicles for an assigned business purpose.

Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.

Licensure/Certification/Registration:

  • Registered Nurse (RN) with a current Florida license required.

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