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Utilization Review Management Jobs in Florida (NOW HIRING)

Enlyte

Utilization Reviewer 2

Tampa, FL

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Genex Services

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

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Showing results 21-40

All JobsUtilization Review Management JobsUtilization Review Management Jobs in Florida

Utilization Review Management information

What are the job titles for utilization review management?

Job titles in utilization review management include Utilization Review Nurse, Utilization Review Coordinator, Utilization Review Nurse Case Manager, and Utilization Review Supervisor. These roles typically involve assessing medical necessity, reviewing patient records, and ensuring compliance with healthcare policies, often requiring certification such as the Certified Professional in Healthcare Quality (CPHQ).

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

AspectUtilization Review ManagementUtilization Review Nurse
CredentialsTypically requires a healthcare management or related certification, sometimes a nursing backgroundRegistered Nurse (RN) license, often with additional utilization review certification
Work EnvironmentOffice-based, administrative setting, collaborating with healthcare providers and insurance companiesClinical setting, reviewing patient charts, and making utilization decisions
Employer & IndustryHealth insurance companies, managed care organizations, healthcare administratorsHospitals, insurance companies, healthcare facilities

Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.

What are some common challenges faced by professionals in utilization review management, and how can they be addressed?

Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.

What is utilization review management?

Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.

What are the key skills and qualifications needed to thrive in utilization review management?

To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.
Utilization Review Management jobs near you
Infographic showing various Utilization Review Management job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Travel Utilization Review RN

ADN Healthcare

Fort Myers, FL • On-site

Contractor

Medical, Dental, Vision, Life

Posted yesterday

New

Job description

ADN Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 09/06/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

Weekly rate listed is an estimate and can vary based on the applicant's home location, VMS Fees, and onboarding costs.
Our Client is currently seeking Utilization Review for positions in Fort Myers, Florida for a 5x8 Days, 09:00:00-17:00:00, 8.00-5 shift.

The ideal candidate will possess a current Florida license. This is a RN position in the Nursing. You must have a Nursing License and at least 2 years of recent experience as a RN – Utilization Review.

Requirements

• Current Resume

• Nursing License per state

• Current BLS and/or ACLS and/or Specialty Certifications

• 2 current clinical references

• Competitive pay rates

• Health/Dental Benefit package

• License reimbursement

• Refer a friend and earn extra cash!

ADN Healthcare Job ID #37756329. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Utilization Review,09:00:00-17:00:00

About ADN Healthcare

ADN Healthcare has thousands of contract and direct hire positions available. We offer medical, dental, and vision coverage.

Benefits
  • Guaranteed Hours
  • Continuing Education
  • Company provided housing options
  • Mileage reimbursement
  • Referral bonus
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • License and certification reimbursement
  • Weekly pay
  • Life insurance
  • Health Care FSA
ADN Healthcare logo

About ADN Healthcare

Sourced by ZipRecruiter

ADN Healthcare is a nurse-centric staffing company backed by a leadership team with over 40 years of combined healthcare staffing experience. Our team’s expertise and industry insights have allowed us to develop and implement organizational metrics that exceed client facility expectations, positioning us as a Tier 1 candidate provider. When you partner with ADN Healthcare, you can trust that you are working with professionals who understand your unique needs and can deliver exceptional results. We are committed to connecting talented candidates with rewarding travel assignments that allow them to build their careers while exploring new locations. With ADN Healthcare, healthcare professionals can embark on a journey of professional growth and fulfill their passion for helping others.

Industry

Recruiting and staffing services

Company size

1 - 10 Employees

Headquarters location

Boynton Beach, FL, US

Year founded

2014

Social media

Facebook

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