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Utilization Review Case Manager Jobs in Spring Hill, FL

Encompass Health

Case Manager

Brooksville, FL

$16.50 - $21.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Brooksville, FL

$16.50 - $21.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health Corporation

Case Manager

Brooksville, FL · On-site

$16.25 - $20.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Certified Case Manager

Lutz, FL

Participate in utilization review process: data collection, trend review, and resolution actions. Participate in case management on-call schedule as needed. Qualifications Must be qualified to ...

Healthcare Support Staffing

RN Case Manager

Tampa, FL

$27 - $32/hr

Calling on patients to review and advise on care planning. May also be speaking with providers to ... Utilization Management exp Knowledge of coding, medical terminology and care planning a must.

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Utilization Review Case Manager information

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

As of Aug 17, 2026, the average hourly pay for utilization review case manager in Spring Hill, FL is $30.95, according to ZipRecruiter salary data. Most workers in this role earn between $25.10 and $32.64 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 Spring Hill, FL?

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

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

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

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

Cities near Spring Hill, 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 Spring Hill, FL as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 21% Part Time, and 1% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $64,386 per year, or $31 per hour.

Case Manager, RN- Utilization Review

Tampa General Hospital (TGH)

Tampa, FL • On-site

Full-time

Posted 8 days ago

Tampa General Hospital rating

7.3

Company rating: 7.3 out of 10

Based on 159 frontline employees who took The Breakroom Quiz

390th of 1,060 rated hospitals

Job description

Under the general supervision of the Utilization Management Manager and in accordance with established policies, professional guidelines, and CMS Conditions of Participation for Utilization Review, the Utilization Management Nurse (UMN) ensures patients are assigned to the most appropriate level of care based on nationally recognized admission and continued stay criteria. The UMN performs admission, concurrent, and retrospective utilization reviews using clinical expertise and medical necessity screening tools; evaluates appropriateness of services and expected length of stay; and supports timely authorization determinations through collaboration with payers. The UMN works closely with physicians, Care Coordinators, Resource Center Associates, Nursing, and leadership to address cases where criteria are not met, escalate concerns to the Physician Advisor or appropriate medical leadership, participate in denial management, and support efficient patient flow. All duties are performed in alignment with Tampa General Hospital's mission, vision, values, and quality standards.
Technical Knowledge, Skills, and Abilitie
  • In-depth knowledge of utilization review processes, nationally recognized medical necessity criteria (e.g., InterQual or similar), and appropriate level-of-care determination.
  • Ability to apply clinical nursing knowledge to evaluate the appropriateness of admissions, continued stays, diagnostic testing, and treatment plans.
  • Knowledge of Medicare, Medicaid, managed care, and commercial payer requirements, including authorization, denial, and appeal processes.
  • Ability to identify cases where criteria are not met, analyze complex clinical and payer-specific issues, and escalate appropriately through physician, Physician Advisor, and leadership channels.
  • Strong communication skills with the ability to effectively collaborate with physicians, payers, interdisciplinary teams, and leadership to justify medical necessity, resolve denials, and support patient flow.
  • Proficiency in accurate, timely documentation of utilization reviews, payer communications, and determinations using electronic medical records and utilization management systems.

Essential Function
  • Conducts initial admission reviews using nationally accepted criteria to determine medical necessity, appropriate level of care, and patient status designation.
  • Performs concurrent and ongoing reviews to assess continued stay, appropriateness of services, and expected length of stay, ensuring alignment with clinical presentation and regulatory requirements.
  • Reviews retrospective cases and participates in denial management, including preparation of clinical documentation and support for appeals in collaboration with Physician Advisors and Appeals teams, when appropriate.
  • Collaborates with payers regarding medical necessity determinations, authorization decisions, and continued stay reviews for inpatient admissions and clinical services.
  • Identifies cases where admission or continued stay criteria are not met and communicates findings with the attending physician, escalating to the Physician Advisor or appropriate medical leadership as needed.
  • Works closely with Care Coordinators, Resource Center Associates, Nursing, Physicians, and leadership to support appropriate patient status, care progression, and effective utilization of hospital resources.
  • Promotes appropriate status designation and medical necessity decisions to support timely patient movement and efficient hospital throughput.
  • Documents all utilization reviews, payer interactions, authorization decisions, clinical findings, and determinations in accordance with departmental standards, regulatory requirements, and organizational policies.
  • Contributes to departmental and organizational performance improvement initiatives related to utilization management, denial reduction, regulatory compliance, and quality outcomes.
  • Performs all duties in accordance with CMS Conditions of Participation, hospital utilization review plans, confidentiality standards, and professional nursing and utilization management guidelines.
  • Proficiency in Microsoft applications, including Outlook, Teams, Word, and Excel, to support clinical documentation, communication, data tracking, reporting, and interdisciplinary collaboration in a remote or hybrid work environment.

Qualifications
  • Licensed as a Registered Nurse in the state of Florida
  • Three (3) years as a practicing RN.
  • Utilization Management experience preferred

What Tampa General Hospital employees say

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About Tampa General Hospital

Sourced by ZipRecruiter

Tampa General Hospital was named the #1 hospital in Tampa Bay by U.S. News & World Report, 2020-2021, and recognized as one of America's Best Hospital's in five medical specialties: Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Nephrology, and Orthopedics. Tampa General Hospital has been designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC), the highest recognition for nursing excellence, for the fourth consecutive time - an accomplishment that fewer than one percent of hospitals nationwide have earned. TGH is accredited by The Joint Commission and was awarded disease-specific certification in five medical specialties. TGH is also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). *Air transport provided by Metro Aviation, Inc.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Tampa, FL, US

Year founded

1927

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