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Utilization Review Lcsw Jobs in Florida (NOW HIRING)

NHC HomeCare - Chipley

Masters Social Worker

Chipley, FL · On-site

Current license as Licensed Clinical Social Worker (LCSW) SOUTH CAROLINA * Current state licensure ... Serves as Utilization Review and/or Advisory Board Member as requested by Administrator/Director of ...

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Utilization Review Lcsw information

What is a utilization review LCSW?

A Utilization Review LCSW (Licensed Clinical Social Worker) is a mental health professional who evaluates the medical necessity, appropriateness, and efficiency of mental health services for patients. They review clinical documentation to ensure that treatments meet insurance and regulatory guidelines, often acting as a liaison between healthcare providers and payers. Their goal is to ensure patients receive necessary care while also reducing unnecessary costs and maintaining compliance with healthcare policies.

What are the key skills and qualifications needed to thrive as a utilization review LCSW?

To thrive as a Utilization Review LCSW, you need a master's degree in social work (MSW), LCSW licensure, and a strong understanding of clinical assessment and care coordination. Familiarity with medical necessity criteria, insurance guidelines, and electronic health record (EHR) systems is essential, and certification in case management or utilization review is often preferred. Exceptional analytical skills, attention to detail, and clear communication help you advocate effectively for patients and collaborate with healthcare teams. These competencies ensure appropriate care, cost-effectiveness, and compliance with regulatory standards in healthcare delivery.

What are the main challenges utilization review LCSWs face when balancing clinical judgment and insurance guidelines?

Utilization Review LCSWs often encounter the challenge of aligning their clinical assessments with insurance coverage criteria, which can sometimes restrict recommended care options. Navigating these situations requires strong communication skills to advocate for appropriate patient care while adhering to payer policies. Frequent collaboration with healthcare providers and insurance representatives is essential to ensure patients receive necessary services without unnecessary delays. This balancing act can be demanding but is also highly rewarding for those who value systemic impact and patient advocacy.

What is the difference between Utilization Review Lcsw vs Medical Social Worker?

AspectUtilization Review LcswMedical Social Worker
CredentialsLicensed Clinical Social Worker (LCSW), certification in utilization review often preferredLicensed Clinical Social Worker (LCSW), with clinical social work experience in healthcare
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, patient homes, healthcare settings
Primary FocusReviewing medical necessity, insurance approvals, and utilization managementProviding psychosocial support, discharge planning, and patient advocacy

The Utilization Review Lcsw primarily focuses on insurance review and utilization management within healthcare settings, requiring knowledge of medical necessity criteria. In contrast, Medical Social Workers provide direct patient support, counseling, and discharge planning. While both roles require an LCSW license, their daily responsibilities and work environments differ significantly.

What are the most commonly searched types of Utilization Review Lcsw jobs in Florida?

The most popular types of Utilization Review Lcsw jobs in Florida are:

What cities in Florida are hiring for Utilization Review Lcsw jobs?

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

Utilization Review Lcsw jobs near you
Infographic showing various Utilization Review Lcsw job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Utilization Review Coordinator

NRG MGMT LLC

Lake Worth, FL • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Job description

Remedial Pro is a specialized medical billing company serving substance abuse treatment and behavioral health providers. Through services including benefits verification, billing and claims submission, and utilization review, we help treatment centers optimize revenue cycle management while focusing on delivering exceptional patient care. Our team is committed to accuracy, professionalism, efficiency, and outstanding client service

JOB DESCRIPTION

The primary goal is to monitor adherence to the facility’s utilization review plan to ensure the effective and efficient use of facility services and monitor the appropriateness of facility  admissions and extended facility stays.

Job Classification: Non Exempt Hourly        Reports To: Senior RCM Director

Supervisory Responsibilities:   None.

JOB DUTIES:

  • Completes Initial, concurrent, peer reviews, and expedited appeals in a timely manner to ensure continuous coverage.
  • responsible for all aspects of the authorization of treatment via insurance and managed care companies.
  • Utilize clinical information and knowledge of Medical Necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
  • Collaborate with facilities in order to obtain necessary clinical documentation for reviews and ensure appropriate lengths of stay and effective utilization of resources.
  • Represents the company in a positive manner per the Professional Standards of Conduct
  • Protects the confidentiality of patients and the privacy of staff
  • provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
  • Uses a computer to type correspondence, reports and other items as requested,
  • Experience in the Mental Health/Addiction space, May be a fully licensed SUDC, CAC,LADC, LCSW, CMHC or RN
  • Additional duties as assigned.

MINIMUM QUALIFICATIONS

  • Bachelor’s or Master’s degree in Behavioral/Mental Health Field (or related experience) preferred
  • A minimum of 3-5 years experience doing utilization review is required preferred
  • Expertise in psychiatric and addiction disorders
  • Experience interacting effectively with co-workers as well as clients.
  • Experience maintaining confidentiality in accordance with HIPAA and company policy requirements.

Required Skills/Abilities:

  • Excellent verbal and written communication skills.
  • Excellent organizational skills and attention to detail.
  • Excellent time management skills with a proven ability to meet deadlines.
  • Proficient with Microsoft Office Suite or related software.
PHYSICAL REQUIREMENTS
  • Prolonged periods sitting at a desk and working on a computer.

Remote Position

Benefits:

• Competitive salary

• Health, dental, and vision insurance

• 401(k) with company match

• Paid time off and holidays

• Continuing education and professional development opportunities

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