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Utilization Management Jobs in Florida (NOW HIRING)

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Minimum five (5) years of Utilization Management, Case Management, Revenue Cycle, or Denials Management experience. * Minimum three (3) years of leadership experience managing hospital UM operations.

Socket.dev

Manager, Utilization Review

Gainesville, FL · On-site

$125 - $150/hr

Minimum five (5) years of Utilization Management, Case Management, Revenue Cycle, or Denials Management experience. * Minimum three (3) years of leadership experience managing hospital UM operations.

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Utilization Management information

See Florida salary details

$29.1K

$66.9K

$121.8K

How much do utilization management jobs pay per year?

As of Sep 8, 2026, the average yearly pay for utilization management in Florida is $66,870.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,200.00 and $78,100.00 per year, depending on experience, location, and employer.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Florida?

The most popular types of Utilization Management jobs in Florida are:

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

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

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

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

What cities in Florida are hiring for Utilization Management jobs?

Cities in Florida with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Florida as of September 2026, with employment types broken down into 90% Full Time, 5% Part Time, and 5% Contract. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $66,870 per year, or $32.1 per hour.

Utilization Management Nurse - Case Management

Melbourne, FL • On-site

Health First
Health Care and Social Assistance • 5 - 10K employees
Learn more about Health Firstexternal

Full-time

Medical, Vision

Re-posted yesterday

Health First rating

7.1

Company rating: 7.1 out of 10

Based on 126 frontline employees who took The Breakroom Quiz

380th of 898 rated healthcare providers

Job description

Job Requirements
POSITION SUMMARY
The Utilization Management (UM) Nurse performs medical necessity reviews on all payer admissions to determine appropriate admission status and documents all information that relates to insurance reimbursement in appropriate reviews for the Health First Integrated Delivery Network (IDN). The UM Nurse utilizes advanced clinical skills to facilitate the provision of care including the appropriate length of stay, patient status management, and resource utilization for all hospital admissions. The UM Nurse effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment and regularly collaborates with the Medical Staff, Physician Advisors, Case Managers, Revenue Cycle and other multi-disciplinary teams.
PRIMARY ACCOUNTABILITIES
  1. Evaluates admissions, continued stays, and services with evidence-based criteria (e.g., InterQual, MCG).
  2. Determines whether care is medically necessary, appropriate, and at the right level of care, and identifies over-utilization and under-utilization.
  3. Verifies compliance with Centers For Medicare and Medicaid Services (CMS) Conditions of Participation, Medicare and Medicaid rules, and Commercial payer requirements.
  4. Maintains accurate, defensible documentation, and supports audits and accreditation standards (e.g., Joint Commission, CMS).
  5. Reviews prior authorizations and concurrent approvals, initiating peer-to-peer reviews when criteria are not met, and manages denials, appeals, and retrospective reviews.
  6. Communicates decisions clearly to providers and stakeholders.
  7. Collaborates closely with licensed practitioners and advanced practice providers, case managers and social workers, coding, billing, and finance teams
  8. Advocates for patients while balancing payer requirements, and promotes efficient, timely progression of care.
  9. Supports appropriate resource utilization without compromising quality.
  10. Identifies opportunities for alternative levels of care (OBS vs IP, SNF, home health, etc.), early discharge planning, while contributing to organizational goals around quality metrics and cost containment.

Work Experience
MINIMUM QUALIFICATIONS
  • Education: Associate's degree in Nursing (ASN), or Nursing Diploma.
  • Work Experience: Five (5) years' experience in acute care (e.g., critical, intermediate, or emergency department) nursing environments.
  • Licensure: Registered Nurse (RN) licensure in the State of Florida, or endorsement.
  • Certification: American Heart Association Basic Life Support (AHA BLS) Healthcare Provider Completion Card prior to start date and maintained.
  • Skills/Knowledge/Abilities:
  1. Strong analytical, data management and computer skills.
  2. Ability to work autonomously and prioritize multiple tasks and role components.
  3. Ability to exercise sound judgment in interactions with physicians, payers, and
  4. other customers.
  5. Must be able to work remotely with adequate technology to support and
  6. maintain productivity.

PREFERRED QUALIFICATIONS
  • Education: BSN or Master's Degree in a healthcare field
  • Certification: Current Case Manager Certification (CCM or ACM)
  • Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement

PHYSICAL REQUIREMENTS
  • Majority of time involves sitting or standing; occasional walking, bending, and stooping.
  • Long periods of computer time or at workstation.
  • Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
  • May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
  • Communicating with others to exchange information.
  • Visual acuity and hand-eye coordination to perform tasks.
  • Workspace may vary from open to confined.
  • May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

What Health First employees say

Pay

Benefits

Hours and flexibility

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About Health First

Sourced by ZipRecruiter

Health First has been providing quality care to Brevard county residents for over 23 years. Health First delivers healthcare services throughout Brevard County with a network comprised of 4 hospitals with 868 beds, a health plan, and outpatient/wellness services including diagnostics, home health care, sleep centers, fitness facilities, pharmacy, cardiac rehabilitation, physical therapy, aging services, a hospice program, and bone/wellness center.

Industry

Health care and social assistance and medical equipment and supplies manufacturing

Company size

5,001 - 10,000 Employees

Headquarters location

Rockledge, FL, US

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