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Utilization Management Jobs in Miami, FL (NOW HIRING)

Solis Health Plans

Utilization Management Nurse

Miami, FL · On-site

$60K - $70K/yr

Under the supervision of the Health Services Director, the Utilization Management Nurse (LPN or RN) uses a multidisciplinary approach to organize, coordinate, monitor, evaluate, create and manage ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is required to meet Foundations standards of customer service and best practices as well as adhere to UHS Code of Conduct. The person must demonstrate excellent ...

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Utilization Management information

See Miami, FL salary details

$37.3K

$85.6K

$155.9K

How much do utilization management jobs pay per year?

As of Aug 10, 2026, the average yearly pay for utilization management in Miami, FL is $85,585.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,700.00 and $99,900.00 per year, depending on experience, location, and employer.

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 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 most commonly searched types of Utilization Management jobs in Miami, FL? The most popular types of Utilization Management jobs in Miami, FL are:
What are popular job titles related to Utilization Management jobs in Miami, FL? For Utilization Management jobs in Miami, FL, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Miami, FL look for? The top searched job categories for Utilization Management jobs in Miami, FL are:
What cities near Miami, FL are hiring for Utilization Management jobs? Cities near Miami, FL with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Miami, FL as of August 2026, with employment types broken down into 87% Full Time, 9% Part Time, and 4% Contract. Highlights an 87% In-person, and 13% Remote job distribution, with an average salary of $85,585 per year, or $41.1 per hour.

Manager, Utilization Management

Independent Living Systems

Miami, FL • On-site

Full-time

Posted 6 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Manager, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Manager, Utilization Management plays a vital role in overseeing the evaluation and authorization of healthcare services to ensure appropriate, cost-effective care delivery. This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for developing and implementing utilization management policies and procedures to ensure compliance with regulatory requirements and industry standards. The Manager, Utilization Management will lead a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate. The Manager, Utilization Management’s role is vital in ensuring that patients receive the highest quality of care while managing costs for the organization.

Minimum Qualifications:

  • Bachelor's degree in nursing, healthcare administration, or related field
  • 3 years of experience in utilization management or related field
  • Experience leading a team of utilization management professionals
  • Strong knowledge of regulatory requirements and industry standards
  • Relevant experience may substitute for the educational requirement on a year-for-year basis

Preferred Qualifications:

  • Master's degree in nursing, healthcare administration, or related field
  • Experience working in a managed care organization
  • Certification in utilization management or related field

Responsibilities:

  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Lead and manage a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate.
  • Manage utilization management processes to ensure efficient and effective use of resources.
  • Utilize established utilization management guidelines to review and authorize medical services.
  • Ensure that medical services are medically necessary and appropriate.
  • Implement utilization management activities in accordance with established policies and procedures.
  • Ensure compliance with regulatory requirements and industry standards.
  • Perform other duties as assigned.


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