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Utilization Management Jobs in Altamonte Springs, FL

Molina Healthcare

Auditor, Clinical Services

Orlando, FL

$29.05 - $56.64/hr

Essential Job Duties Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with ...

Molina Healthcare

Auditor, Clinical Services

Orlando, FL

$29.05 - $56.64/hr

Essential Job Duties • Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with ...

Molina Healthcare

Auditor, Clinical Services

Orlando, FL

$29.05 - $56.64/hr

Essential Job Duties • Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with ...

Orlando Health

Care Management - Manager

Orlando, FL · On-site

Serves as facilitator to physicians and nursing staff on utilization and discharge planning, care coordination, and utilization management issues. Demonstrates the knowledge of labor and expense ...

EmpiRx Health, LLC

Director, Prior Authorization

Orlando, FL · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

This role manages a team of pharmacists and technicians responsible for clinical reviews, utilization management, and appeals processing while ensuring compliance with regulatory, clinical, and ...

Actalent

Remote Pediatric Case Manager RN

Orlando, FL

$40 - $44/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Collaborate with utilization management and care coordination teams to ensure services are medically necessary, appropriate, and cost‑effective. * Ensure case management activities comply with ...

Akerman

Manager of Paralegal Services

Orlando, FL · Hybrid

Partner with Human Resources on employee relations, performance management, and talent development. * Monitor utilization, workload, productivity, and staffing across offices and practice groups.

Akerman

Manager of Paralegal Services

Orlando, FL · On-site

Partner with Human Resources on employee relations, performance management, and talent development. * Monitor utilization, workload, productivity, and staffing across offices and practice groups.

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Showing results 21-40

All JobsUtilization Management JobsUtilization Management Jobs in Altamonte Springs, FL

Utilization Management information

See Altamonte Springs, FL salary details

$36.7K

$84.2K

$153.4K

How much do utilization management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for utilization management in Altamonte Springs, FL is $84,201.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,700.00 and $98,300.00 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 are popular job titles related to Utilization Management jobs in Altamonte Springs, FL?

For Utilization Management jobs in Altamonte Springs, FL, the most frequently searched job titles are:

What cities near Altamonte Springs, FL are hiring for Utilization Management jobs?

Cities near Altamonte Springs, FL with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Altamonte Springs, FL as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $84,201 per year, or $40.5 per hour.

RN Care Manager - Full Time - Day - Corp Care management

Orlando Health

Orlando, FL • On-site

Full-time

Posted 5 days ago

Orlando Health rating

7.4

Company rating: 7.4 out of 10

Based on 617 frontline employees who took The Breakroom Quiz

268th of 887 rated healthcare providers

Job description

Position Summary
Company is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.
A Brief Overview
Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patients most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care.
What you will do
  • Initially and concurrently assesses all patients within assigned population to include, but not limited to:
  • Accurate medical necessity screening and submission for Physician Advisor review
  • Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information.
  • Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines.
  • Leading and facilitating multi-disciplinary patient care conferences
  • Managing concurrent disputes
  • Making appropriate referrals to other departments
  • Identifying and referring complex patients to Social Work Services
  • Communicating with patients and families about the plan of care
  • Leading and facilitating Complex Case Review
  • Identification and documentation of potentially avoidable days
  • Identification and reporting over and underutilization
  • Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid, and Campus related to admission and continued stay approval.
  • Adheres to Utilization Management Plan.
  • Integrates National standards for care management scope of services including:
  • Utilization Management supporting medical necessity and denial prevention
  • Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
  • Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level of care
  • Education provided to physicians, patients, families, and caregivers.
  • Communicates appropriately and timely with the interdisciplinary team and third-party payers.
  • Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas.
  • Develops collaborative relationships with patient business, nursing, physicians, and patient/family to facilitate efficient movement through the continuum of care.
  • Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement.
  • Forwards identified quality and/or risk issues appropriately.
  • Maintains positive relationships with outside/onsite reviewers and other payer representatives.
  • Identifies cultural, socio-economic, religious, and other factors that may impact treatment.
  • Involves patient's family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family.
  • Reviews patient's discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members.
  • Prioritizes workload to manage multiple priorities while using problem-solving skills to meet goals.
  • Enhances professional growth by participating in educational programs, current literature and/or workshops.
  • Possesses excellent interpersonal skills and ability to work in a team environment.
  • Respects the rights and privacy of others and holds staff member information in strict confidence.
  • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
  • Maintains compliance with all Orlando Health policies and procedures.
  • Maintains records and documentation of work performed in an organized and easily retrievable fashion while maintaining confidentiality of data and patient information.
  • Reviews current literature on a regular basis, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information.
  • Actively serves on committees and task forces to promote quality, cost-effective care for patient population.
  • Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy.
  • Performs other duties as assigned or required.

Qualifications
Qualifications
  • Graduate of an approved school of nursing.
  • Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.
  • Must hold and maintain a current Florida RN license.
  • Handle with Care (HWC) Certification is required for the Behavioral Health Unit within 90 days of hire. The Handle with Care training and education will be provided onsite to all team members.

Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be a part of a work family that values collaboration, innovation and dedication, we're the right company for you.
Section 1557 Non-Discrimination
The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 42 U.S.C. 18116.

What Orlando Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Orlando Health

Sourced by ZipRecruiter

Orlando Health is a 3,200-bed system that includes 15 wholly-owned hospitals and emergency departments; rehabilitation services, cancer institutes, heart institutes, imaging and laboratory services, wound care centers, physician offices for adults and pediatrics, skilled nursing facilities, an in-patient behavioral health facility, home healthcare services in partnership with LHC Group, and urgent care centers in partnership with CareSpot Urgent Care. Nearly 4,200 physicians, representing more than 80 medical specialties and subspecialties have privileges across the Orlando Health system, which employs nearly 22,000 team members. Areas of clinical excellence are orthopedics, heart and vascular, cancer care, neurosciences, surgery, pediatric specialties, neonatology, women's health and trauma.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Orlando, FL, US

Year founded

1918

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