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Utilization Review Case Manager Jobs in Hialeah, FL

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Hialeah, FL

Utilization Review Case Manager information

See Hialeah, FL salary details

$15

$33

$54

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

As of Aug 31, 2026, the average hourly pay for utilization review case manager in Hialeah, FL is $33.04, according to ZipRecruiter salary data. Most workers in this role earn between $26.78 and $34.86 per hour, depending on experience, location, and employer.

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 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 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 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 popular job titles related to Utilization Review Case Manager jobs in Hialeah, FL?

For Utilization Review Case Manager jobs in Hialeah, FL, the most frequently searched job titles are:

What job categories do people searching Utilization Review Case Manager jobs in Hialeah, FL look for?

The top searched job categories for Utilization Review Case Manager jobs in Hialeah, FL are:

What cities near Hialeah, FL are hiring for Utilization Review Case Manager jobs?

Cities near Hialeah, FL 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 Hialeah, FL 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 $68,731 per year, or $33 per hour.

Utilization Review Nurse

Fort Lauderdale, FL

Healthcare Support Staffing
Recruiting and Staffing Services • 201 - 500 employees
Learn more about Healthcare Support Staffingexternal

$28.85 - $31.25/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 28 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description
  • Conducts pre-admission, concurrent and retrospective acute care, sub-acute, hospice, qualification of transitional care and long-term care needs for medical necessity
  • Perform case reviews and complete all required documentation in appropriate database
  • Collaborate with primary or attending physician, case managers, patient and/or family to provide continuity and quality of care in the most cost-effective manner.
  • Timely completion of admission reviews (within 48-hours for weekday, 72-hours for weekend)
  • Provide outpatient or pharmacy services utilization review
Qualifications
  • Current Florida RN License
  • 3+ years in recent medical/surgical or critical care experience
  • 3+ years of Utilization Review / Case Management experience
  • Strong reasoning ability: define problems, collect data, establish facts, and draw conclusions
Additional Information

 Hours for this Position:

  • M-F 8-5

Advantages of this Opportunity:

Competitive salary 

  • $28.85/hr - $31.25/hr pending experience
  • Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO
  • Growth potential
  • Fun and positive work environment
Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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