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Utilization Management Jobs in Gainesville, FL (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.

Posted today

UF Health

Manager, Inpatient CDI

Gainesville, FL

$31.50 - $42.50/hr

Minimum three (3) years of progressive leadership experience in CDI, coding, case management, utilization management, health information management, or related healthcare operations. * Experience in ...

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Utilization Management information

See Gainesville, FL salary details

$35.4K

$81.1K

$147.7K

How much do utilization management jobs pay per year?

As of Sep 7, 2026, the average yearly pay for utilization management in Gainesville, FL is $81,110.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,500.00 and $94,700.00 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 Gainesville, FL?

The most popular types of Utilization Management jobs in Gainesville, FL are:

What are popular job titles related to Utilization Management jobs in Gainesville, FL?

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

What job categories do people searching Utilization Management jobs in Gainesville, FL look for?

The top searched job categories for Utilization Management jobs in Gainesville, FL are:

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

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

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Gainesville, FL as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $81,110 per year, or $39 per hour.

RN, Utilization Management | Utilization Management| Night | Part Time

UF Health

Gainesville, FL • On-site

Other

Re-posted 19 days ago

Job description

Overview
Make an impact by supporting the right care at the right time through utilization management excellence.
Work Style: Onsite
Location: Gainesville, FL
FTE: Part-Time (.6 FTE)
Schedule: Wednesday - Thursday - 7:00 PM - 7:00 AM
Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
Responsibilities
Key Responsibilities
  • Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
  • Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
  • Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
  • Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
  • Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.
Qualifications
Education & Licensure
  • Registered Nurse (RN) with a current Florida nursing license required.
Experience & Skills
  • Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
  • Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
  • Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
  • Strong communication and collaboration skills related to authorization determinations and care coordination.
  • Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.

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