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Utilization Review Case Manager Jobs in Florida (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

This includes the implementation of case management scenarios, consulting with all services to ... experience in Utilization Review/ Management. Has knowledge of regulatory and reimbursement ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

GLC On-The-Go

Travel Utilization Review RN

Fort Myers, FL · On-site

$2.0K - $2.1K/wk

Specialty: Case Management * Discipline: RN * Start Date: 09/07/2026 * Duration: 13 weeks * 40 ... Registered Nurse - Utilization Review About GLC On-The-Go GLC is more than just a staffing agency ...

New

Memorial Healthcare

The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...

American Traveler

Travel Case Manager

Fort Myers, FL · On-site

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

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Utilization Review Case Manager information

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$12

$27

$44

How much do utilization review case manager jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization review case manager in Florida is $27.27, according to ZipRecruiter salary data. Most workers in this role earn between $22.12 and $28.75 per hour, depending on experience, location, and employer.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Florida? For Utilization Review Case Manager jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Florida look for? The top searched job categories for Utilization Review Case Manager jobs in Florida are:
What cities in Florida are hiring for Utilization Review Case Manager jobs? Cities in Florida with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 13% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $56,713 per year, or $27.3 per hour.

Utilization Mgmt Case Mgr II

Sarasota Memorial Health Care System

Sarasota, FL • On-site

Full-time

Re-posted 14 hours ago

Sarasota Memorial Health Care System rating

7.5

Company rating: 7.5 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

235th of 887 rated healthcare providers

Job description

Department
Integrated Case Management
Job Summary
The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care. The UMCM maintains a strong knowledge base of evidence-based clinical criteria, federal and state UR requirements, and adeptly identifies pertinent clinical information that will support admission and continued stay hospitalization. When potential denials for payment or level of care arise, the UMCM collaborates with the floor ICM staff, Revenue Cycle, involved physicians and/or the Physician Advisors (PA) as needed to attain second level review/approval to effectively overturn the denial or help determine appropriate transition for the patient. UMCM interact extensively with clinical staff throughout the hospital, other ICM staff, physicians, payers, and hospital financial staff in order to achieve appropriate level of care or placement authorizations, and to avoid denials. The UMCM collaborates with other ICM staff to evaluate opportunities to optimize utilization and secure payer approvals across populations of patients to meet organizational strategic objectives. The UMCM acts as a mentor/preceptor for new staff.
Required Qualifications
- Require a Bachelor of Science in Nursing (BSN) from an accredited school of nursing.
- Require three (3) years of utilization review experience.
- Require a minimum of three (3) years in an acute care setting.
- Require previous experience with hospital information systems (order entry, results reporting, case management).
- Require basic experience using PC/computer (word processing minimum).
Preferred Qualifications
- Prefer active Case Management Certification (CCM or ACM) or within one (1) year of hire and membership in relevant CM/UM organization.
- Prefer demonstrated ability to manage multiple tasks and adjust priorities according to patient and department/hospital needs.
- Prefer solid clinical assessment, critical thinking, decision making and organizational skills.
- Prefer strong ability to communicate effectively both verbally and in written work.
- Prefer strong interpersonal skills and ability to work collaboratively with leaders, staff, patients, families, healthcare team, payers and external agencies.
- Prefer knowledge of relevant federal and state utilization review and appeal requirements.
Mandatory Education
Preferred Education
Required License and Certs
FL RN: FL Registered Nurse License
Preferred License and Certs
Rotating weekends, Hybrid role
Employment Screening Requirements
As part of Sarasota Memorial Health Care System's commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/

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About Sarasota Memorial Health Care System

Sourced by ZipRecruiter

Sarasota Memorial Health Care System, based in Sarasota, FL, US, is a community-owned and operated healthcare provider entrenched in the medical and health services industry. Known for offering a wide array of comprehensive care, their extensive services range from disease prevention and detection to advanced treatment and rehabilitation. The company, established in 1925, began as a 14-bed hospital and has evolved into an 839-bed regional medical center, becoming one of the region's largest public health systems. Sarasota Memorial's mission is to deliver healthcare service of the highest quality in keeping with their core values, including community, excellence, loyalty, innovation, respect, and teamwork.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Sarasota, FL, US

Year founded

1925

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