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Utilization Management Jobs in New Port Richey, FL

Liberty Dental Plan Careers

Senior Staff Dentist

Tampa, FL · Remote

$175K - $185K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations

LIBERTY DENTAL

Senior Staff Dentist

Tampa, FL · On-site +1

$175K - $185K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations

Molina Healthcare

Auditor, Clinical Services

Tampa, 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 ...

BayCare Health System

Manager Site II

Wesley Chapel, FL · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

In a minimally complex practice, oversees the utilization management and daily business operations of the physician practice at the facility. * Possesses a clear understanding of the financial ...

Elevance Health

Medical Mgmt Specialist I (contract)

Tampa, FL · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Requirements : * Requires a H.S. diploma or equivalent and a ...

Elevance Health

Medical Mgmt Specialist I (contract)

Tampa, FL · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Requirements : * Requires a H.S. diploma or equivalent and a ...

Elevance Health

Sr Test Analyst PBM

Tampa, FL · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing. * Identify, triage, and collaborate with business and adjudication teams to resolve defects efficiently ...

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Showing results 21-40

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 Aug 16, 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 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 popular job titles related to Utilization Management jobs in New Port Richey, FL?

For Utilization Management jobs in New Port Richey, FL, the most frequently searched job titles are:

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, 76% Full Time, 16% Part Time, and 7% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $79,701 per year, or $38.3 per hour.

Physician Advisor 7 on 7 off

Brundage Group

Pinellas Park, FL • On-site

Other

Re-posted 13 days ago

Job description

Job Type
Full-time
Description
*Please note: Experienced Physician Advisor's only and no part time inquiries*
The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA conducts case reviews to ensure compliance, appropriate and accurate clinical documentation, and appropriate utilization of health care services. The PA will meet with hospital personnel and medical staff when needed to provide education and expertise. The PA acts as a consultant and resource for attending physicians regarding appropriate status, utilization of resources, need for continued hospitalization, compliance concerns and tracking and reporting of quality and complications. The PA will also interact with medical directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care.
Requirements
GENERAL SUMMARY:
The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA conducts case reviews to ensure compliance, appropriate and accurate clinical documentation, and appropriate utilization of health care services. The PA will meet with hospital personnel and medical staff when needed to provide education and expertise. The PA acts as a consultant and resource for attending physicians regarding appropriate status, utilization of resources, need for continued hospitalization, compliance concerns and tracking and reporting of quality and complications. The PA will also interact with medical directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care.
DUTIES AND RESPONSIBILITIES:
Utilization Management Functions

  • Reviews medical records of patients identified by the UM team or as requested by the healthcare team
  • Perform status determinations including 2nd level reviews and continued stay reviews for traditional Medicare patients and all other payors
  • Review Code 44 cases
  • Assist with length of stay management
  • Work with case management and the interdisciplinary team to ensure appropriate continuity of care and reduce readmissions
  • Communicate with the medical staff through secure email, secure texting applications, phone calls and face to face interactions to relay important information and provide education
  • Act as a liaison between Utilization Management/Case Management and providers to collaborate on appropriate plans of care
  • Review and suggest improvements related to resource allocation
  • Optimize coordination of care processes
  • Provide guidance to ED Physicians and the UM/CM team regarding alternatives to acute care
Denials Management Functions
  • Review denials and author appeal letters as needed
  • Perform peer to peers with payors
  • Act as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriate
  • Other duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES: Abilities may be accessed through written, verbal, and other evaluation methods.
  • Expertise in Utilization Management preferred
  • Strong interpersonal skills
  • Excellent written and verbal communication skills
  • Ability to work independently
  • Ability to build relationships with key hospital team members
WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS: List preferred/required work experience, education, and certifications.
MD or DO
Current, unrestricted medical license in state of residence
Demonstrated ability to build rapport with medical staff and hospital leadership
Strong computer skills and working knowledge of EMRs
1-3 years of Physician Advisor experience and clinical experience in a hospital-based setting
Preferred Qualifications:
  • Board Certified / Eligible
  • CCDS or CDIP
  • CCS
  • CHCQM certification (ABQAURP)

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:
Conditions typically associated with an office environment. While performing the essential duties and
responsibilities, the employee is regularly required to talk or hear. May be frequently required to sit, stand or
walk. Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physical
activity that may include lifting 25 pounds. Subject to exposure to all environmental hazards associated with
healthcare and office work.

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