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Utilization Management Jobs in New Port Richey, FL

SPEROS

RN Utilization Review - Full Time Days

Tampa, FL · On-site

$77 - $118/hr

Knowledge of utilization management principles, medical necessity determination, and denial mitigation. * Ability to analyze clinical documentation and apply established criteria. * Ability to work ...

New

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Detail-oriented with strong organizational skills to manage multiple cases efficiently.

Enlyte

Utilization Reviewer 2

Tampa, FL

$59K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Detail-oriented with strong organizational skills to manage multiple cases efficiently.

NTT DATA Services

BPO Senior Manager

Tampa, FL · Remote

$93K/yr

Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA standards, Medicaid regulations, and medical necessity review requirements. * Demonstrated expertise ...

Prime Staffing

Travel Case Management RN

Largo, FL · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

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All JobsUtilization Management JobsUtilization Management Jobs in New Port Richey, FL

Utilization Management information

See New Port Richey, FL salary details

$34.7K

$79.7K

$145.2K

How much do utilization management jobs pay per year?

As of Sep 2, 2026, the average yearly pay for utilization management in New Port Richey, FL is $79,701.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,400.00 and $93,100.00 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 job categories do people searching Utilization Management jobs in New Port Richey, FL look for?

The top searched job categories for Utilization Management jobs in New Port Richey, FL are:

What cities near New Port Richey, FL are hiring for Utilization Management jobs?

Cities near New Port Richey, FL with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in New Port Richey, FL as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 18% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $79,701 per year, or $38.3 per hour.

Utilization Management Assistant

BayCare Health System

Clearwater, FL • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 10 days ago

BayCare Health System rating

7.4

Company rating: 7.4 out of 10

Based on 406 frontline employees who took The Breakroom Quiz

267th of 898 rated healthcare providers

Job description

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
The Utilization Management Assistant responsibilities include:
  • Participating on the Utilization Management Team (UMT), serving as a Utilization Management liaison with managed care organizations, collaborating with Medical Staff, Business Office, Medical Records and other hospital staff.
  • Provides support services to the staff of the UM department.
  • Provides assistance with coordination of case management services and various administrative duties.

Position details:
  • Location: Hybrid - Morton Plant Hospital - Clearwater, FL
  • Status: Full Time, 40 hours per week
  • Schedule: Monday - Friday 8:00 AM - 4:30 PM
  • Weekend Requirement: Every 3rd
  • On Call: No

Education:
  • Required High School Diploma or Equivalent

Experience:
  • Required 2 years in Case Management
  • Or 2 years in Medical Billing
  • Or 2 years in Registration

Benefits:
  • Benefits (Health, Dental, Vision)
  • Paid time off
  • Tuition reimbursement
  • 401k match and additional yearly contribution
  • Yearly performance appraisals and team award bonus
  • Community discounts and more

Equal Opportunity Employer Veterans/Disabled

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