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Utilization Review Assistant Jobs in Florida (NOW HIRING)

Elevance Health

Utilization Management Rep III

Tampa, FL · On-site

... review. How you will make an impact: * Responsible for providing technical guidance to UM Reps who ... May assist in new hire training to act as eventual proxy for Ops Expert. * Exemplifies behaviors ...

Guardian Recovery

UR COORDINATOR

Delray Beach, FL · On-site

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of ... Organize and filing documents for ease of access in approved locations. * Assist in compiling ...

genex

Telephonic Case Manager

Boca Raton, FL · On-site

Responsible for the performance of Utilization Review services, including pre-admission ... May assist in training/orientation of new staff as requested. Monitors functions assigned to non ...

genex

Telephonic Case Manager

Boca Raton, FL · On-site

Responsible for the performance of Utilization Review services, including pre-admission ... May assist in training/orientation of new staff as requested. Monitors functions assigned to non ...

Genex

Telephonic Case Manager

Boca Raton, FL · On-site

Responsible for the performance of Utilization Review services, including pre-admission ... assist in training/orientation of new staff as requested. • Monitors functions assigned to non ...

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Utilization Review Assistant information

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

What are the most commonly searched types of Utilization Review jobs in Florida?

The most popular types of Utilization Review jobs in Florida are:

What are popular job titles related to Utilization Review Assistant jobs in Florida?

For Utilization Review Assistant jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Utilization Review Assistant jobs in Florida look for?

The top searched job categories for Utilization Review Assistant jobs in Florida are:

What cities in Florida are hiring for Utilization Review Assistant jobs?

Cities in Florida with the most Utilization Review Assistant job openings:

Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Part-Time Concurrent Review RN - Every Saturday and Sunday

Guidewell

Jacksonville, FL • On-site

$71K - $115K/yr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 3 days ago. Applications are no longer accepted.

Job description


This position is a part-time permanent role, 16 hours per week, every Saturday and Sunday.
The CRN is responsible for performing medical reviews using established criteria to ensure the member is receiving care at the most appropriate level. The CRN builds relationships with facility case managers to facilitate appropriate care and discharge planning. The CRN is responsible for identifying appropriate care programs for members to ensure a smooth transition from facility to home and to decrease frequency of readmission.
What You Will Be Doing
  • Serve as a point of contact for providers to assist in navigating members them through the continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access
  • Evaluate members in the Hospital, Skilled Nursing Facility, LTAC, Acute Inpatient Rehab for benefit determination, medical necessity and appropriate level of care utilizing member benefits and InterQual or other medical necessity criteria.
  • Participate in weekly case review
  • Determine member's discharge status and identify and coordinate any additional needs and services that require ongoing Care Coordination services
  • Collaborate with Medical Directors, Managers, Co-workers and other departments including Case Management and Care Partners

What We Require
  • 2+ years related work experience.
  • Experience Details: Recent (within the past 3-5 years) clinical experience in a hospital, LTAC, Rehab, SNF setting evaluating hospital benefit determination, medical necessity and appropriate level of care
  • Related Bachelor's degree or additional related equivalent work experience
  • Unrestricted US Registered Nurse license
  • Florida State Licensure and/or Compact State Licensure
  • Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case management Referrals for possible
  • Case Management activities that focus on acute and non-acute services, outpatient services and/or community resources
  • Experience with the Healthcare industry and Managed Care Experience in MS Word and Excel Moderate to heavy keying required
  • Occasional travel within the State of Florida

What We Prefer
  • Bachelor's degree Nursing, Healthcare or Business
  • Utilization Review/Management

General Physical Demands
  • Exerting up to 10 pounds of force occasionally to move objects.
  • Jobs are sedentary if traversing activities are required only occasionally.

This position offers a hybrid work arrangement which combines flexibility with in-office engagement. Team schedules are determined based on role requirements and business needs. Travel to and from our corporate or regional offices may be required.
What We Offer
Based on your job designation, as a Florida Blue employee, you will be at the heart of GuideWell's vision - to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits: life insurance, short- and long-term disability programs
  • Leave programs to support personal circumstances
  • Retirement Savings Plan including employer match
  • Paid time off, volunteer time off, 10 holidays and 2 well-being days
  • Additional voluntary benefits available; and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Typical Annualized Offer/Hiring Range: $71,200 - $89,000
Annualized Salary Range: $71,200 - $115,700
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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