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Utilization Review Management Jobs in Florida (NOW HIRING)

Care Career

Travel Utilization Review RN

Fort Myers, FL · On-site

Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

Care Career

Travel Utilization Review RN

Fort Myers, FL · On-site

Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

GQR Healthcare

Travel Utilization Review RN

Fort Myers, FL · On-site

$1.7K - $1.8K/wk

GQR Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

GQR Healthcare

Travel Utilization Review RN

Fort Myers, FL · On-site

$1.7K - $1.8K/wk

GQR Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

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Utilization Review Management information

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.

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 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.

How do I get into utilization review management?

To enter utilization review management, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of medical billing and coding. Obtaining relevant certifications such as the Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM) can improve job prospects, and strong analytical, communication, and organizational skills are essential for success in this role.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.
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, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution.

Utilization Review Nurse

Tampa, FL

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

$29 - $30/hr

Full-time

Re-posted 19 days ago

Key responsibilities

  • Review medical information for assigned medical records, including quality of care and medical necessity.

  • Communicate with healthcare providers, Medicare beneficiaries, and family members to clarify information and respond to requests.

  • Collaborate with the team to identify process improvements and support contract requirements.

Job description

Company Description

Why You Should Work For Us:

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

You, as the Nurse Reviewer will be held responsible for the comprehensive review of the medical information for the assigned medical record review and completion of all paperwork, communication and data entry involved. Reviews will include quality of care, medical necessity; DRG validation, focused, readmission, Emergency Medical Treatment and Active Labor Act [EMTALA], and all others are required by contract. Communicates with the Medicare beneficiary/family members, healthcare providers and/or practitioners as needed during the course of the identified review.

Essential Duties:

Maintains current knowledge of the QIO contract, QIO Manual, SDPS Memorandums and Healthcare Communities Website to locate and apply up to date rules and protocols

Recognizes barriers to completing work and uses clinical judgment to determine when to seek assistance from the Review Supervisor

Communicates with the providers/practitioners via mail or phone regarding the need for clarification of requests and information provided in the correspondence letters.

Responds in a timely manner to the providers and/or practitioners if there is a request for information or assistance in order to facilitate the completion of the assigned medical record reviews.

Applies knowledge and expertise, analytical skills, critical thinking and business acumen to best meet customer needs.

Communicates with Medicare beneficiary via mail or phone as needed

Responds in a timely manner to the beneficiary if there is a request for information

Frequently seeks and accepts feedback with regards to the review process; listens actively; maintains frequent and open communication.

Collaborates to accomplish common goals to include accurate medical assessment of the beneficiary complaint and accurate Quality of Care Reviews.

Recommend actions that may increase quality /productivity related to the review process.

Communicates the current status of workload and availability for additional assignments

Collaborates with the KEPRO team to identify additional process improvements that support enhanced beneficiary satisfaction and overall improvement of heal care.

Collaborates with the KEPRO staff to support all contract requirements and identify additional contract improvements.


Qualifications

Active RN or LPN Licensure

Graduate from an accredited School of Nursing or college

3+ years of clinical experience within any healthcare setting [Acute Care, Inpatient, Outpatient, etc]

Quality Review experience [Medical Necessity, Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews]


Additional Information

Shift: Monday - Friday 8:00am - 5:00pm

This is an immediate contract opening!

Pay range $29.00 - $30.00/hr), salary negotiated based on relevant experience


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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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