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Utilization Review Director Jobs in Florida (NOW HIRING)

Leon Medical Centers

Concurrent Review Nurse

Doral, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills

Leon Health Plan

Concurrent Review Nurse

Doral, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills

Sunshine State Health Plan

Medical Director

Miami, FL · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...

Sunshine State Health Plan

Medical Director

Hialeah, FL · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...

Sunshine State Health Plan

Medical Director

Tallahassee, FL · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...

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All JobsUtilization Review JobsUtilization Review Director JobsUtilization Review Director Jobs in Florida

Utilization Review Director information

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$15

$31

$51

How much do utilization review director jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for utilization review director in Florida is $31.60, according to ZipRecruiter salary data. Most workers in this role earn between $24.95 and $36.30 per hour, depending on experience, location, and employer.

What does a utilization review director do?

A Utilization Review Director oversees the evaluation of medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead teams that review patient care requests, manage compliance with regulations, and implement strategies to ensure cost-effective care without compromising quality. Their responsibilities often include policy development, data analysis, and collaboration with healthcare providers to optimize resource use and improve patient outcomes.

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

To thrive as a Utilization Review Director, you need a deep understanding of clinical guidelines, healthcare regulations, and case management principles, typically supported by a nursing or related healthcare degree and relevant licensure. Familiarity with utilization management software, electronic health records (EHR), and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) is common in the field. Strong leadership, communication, analytical thinking, and decision-making skills help you effectively manage teams and ensure compliance. These competencies ensure efficient resource use, regulatory adherence, and high-quality patient outcomes within healthcare organizations.

What are some common challenges faced by a utilization review director, and how can they be addressed?

A Utilization Review Director often navigates challenges such as balancing regulatory compliance with organizational goals, managing interdisciplinary teams, and keeping up with evolving healthcare policies. Staying proactive with ongoing education, fostering open communication among staff, and implementing efficient review processes can help address these issues. Additionally, leveraging data analytics and technology streamlines case reviews and ensures evidence-based decision-making, ultimately improving both patient outcomes and operational efficiency.

What is the difference between Utilization Review Director vs Utilization Review Nurse?

AspectUtilization Review DirectorUtilization Review Nurse
CredentialsRN license, management experience, certifications (e.g., CCM)RN license, certification in case management or utilization review (e.g., CUC)
Work EnvironmentAdministrative, leadership roles overseeing teamsClinical, review of patient cases, direct patient care
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentLeadership, management, strategic planning in utilization reviewClinical review, case assessment, patient care coordination

The Utilization Review Director typically oversees review teams and manages utilization strategies, requiring leadership skills and management experience. In contrast, the Utilization Review Nurse focuses on clinical case assessments and patient care reviews. Both roles require RN licensure and relevant certifications but differ mainly in scope and responsibilities.

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 cities in Florida are hiring for Utilization Review Director jobs?

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

Utilization Review Director jobs near you

Travel RN Case Manager, Utilization Review

AMN Healthcare Revenue Cycle

Boca Raton, FL • On-site

$1.8K - $2.5K/wk

Contractor

Medical, Dental, Vision, Life, Retirement

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

Job description

AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Boca Raton, Florida.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Duration: 13 weeks
  • 36 hours per week
  • Shift: 12 hours
  • Employment Type: Travel

Job Description & Requirements
RN Case Manager, Utilization Review
StartDate: ASAP Pay Rate: $1800.00 - $2500.00
POSITION SUMMARY 
RN Case Manager, Utilization Review (On-site) 
POSITION DUTIES The RN Case Manager (Home Health Review) plays a crucial role in monitoring post-acute patients to ensure they continue to meet the CMS criteria for services. As a key member of the patient’s care team, the RN Navigator acts as a patient advocate, providing proactive outreach to post-acute facilities to review patient needs. The Nurse makes recommendations to primary care providers regarding ongoing services and facilitates communication and coordination of care with clinic providers. 
Stays updated on current CMS and other payer guidelines for post-acute Home Health services to ensure compliance. Receives and evaluates post-acute Home Health 485 forms (Plan of Care) based on Medical Necessity guidelines and Homebound Status requirements. Facilitates Case Conferences with post-acute agencies to evaluate patient progress toward goals and discharge plans. Ensures post-acute agencies address the problem list and provide appropriate follow-up for patient needs.
This role does not involve direct patient care or patient contact. Instead, the nurse works collaboratively with home health agencies to review Plans of Care, ensure recertifications are appropriate, support compliance with Medicare guidelines, and help ensure patients are receiving the right level of care.
MINIMUM REQUIRED QUALIFICATIONS 
EPIC experience required 
Must be licensed in Texas (RN)
Must have knowledge of Medicare (Parts A & B)Must have at least 2 years Home Health experience 
LENGTH OF ASSIGNMENT 12 Weeks 
SHIFT / HOURS PER WEEK 
Days, M-F 8am-5pm
SYSTEMS 
EPIC
START DATE  8/31/2026
Facility Location
Positioned on the southern tip of sunny Florida, this beach town is one of the Sunshine State’s crown jewels. You’ll find unique Spanish and Mediterranean architecture throughout the city as well as swanky boutiques and chic cafés. From the revitalized shopping area of Minzer Park to the sparkling blue waters that border the city, Boca Raton is a place that many people would long to call home.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:

  • Medical, dental and vision benefits
  • Earned time off and paid holidays
  • Paid continuing education time
  • 401(K) retirement planning
  • Short-term disability, life insurance, paid jury duty
  • Access to the largest network of facilities and providers in the country
  • Industry experienced workforce management team
  • Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

AMN Healthcare Revenue Cycle Job ID #3561045. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN Case Manager, Utilization Review

About AMN Healthcare Revenue Cycle

AMN Healthcare is a leading force in the healthcare industry, committed to being the most trusted, innovative, and influential partner for healthcare organizations. With a focus on providing quality patient care, AMN Healthcare offers holistic solutions that reduce costs, streamline processes, and improve efficiencies. The company boasts over 30 years of experience and takes pride in staffing leading healthcare facilities with the nation's best travelers. As an industry leader, AMN Healthcare offers a diverse team dedicated to supporting healthcare workers and facilities, ensuring a personalized and supportive experience for both clients and candidates.

Benefits
  • Medical benefits
  • Dental benefits
  • Company provided housing options
  • Continuing Education

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