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Utilization Review Assistant Jobs in Florida (NOW HIRING)

Florida Blue

Concurrent Review Nurse

Jacksonville, FL · On-site

$71K - $115K/yr

Serve as a point of contact for providers to assist in navigating members them through the ... Utilization Review/Management General Physical Demands * Exerting up to 10 pounds of force ...

Leon Health, Inc.

Concurrent Review Nurse

Miami, FL · On-site

Work with providers to proactively identify discharge needs and assist in care planning ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills

Guardian Recovery

UR COORDINATOR

Delray Beach, FL · On-site +1

$60K - $70K/yr

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 ...

Turning Point Plans

Clinical Review Nurse

Lake Mary, FL · On-site

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... * Assist clinical staff in quality improvement projects to provide instructive feedback to clients ...

genex

Telephonic Case Manager

Boca Raton, FL

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 ...

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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 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.

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 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 100% Full Time. Highlights an 95% In-person, and 5% Remote job distribution.

Utilization Specialist

North Tampa Behavioral Health

Wesley Chapel, FL • On-site

Full-time

Posted 11 days ago

Job description

Overview

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

AHMKT

Employment Type: FULL_TIME

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