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Utilization Review Manager Jobs in Florida (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... In this remote role, you'll manage a caseload of 50-75 patients, conducting admission and ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...

Miami Jewish Health

Utilization Review Nurse

Miami, FL · On-site

All utilization management activities are performed in accordance with CMS PACE regulations (42 CFR ... Concurrent Review & Care Progression * Conducts timely concurrent reviews with hospitals and ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Florida

Utilization Review Manager information

See Florida salary details

$29.1K

$68K

$125.2K

How much do utilization review manager jobs pay per year?

As of Aug 10, 2026, the average yearly pay for utilization review manager in Florida is $68,012.00, according to ZipRecruiter salary data. Most workers in this role earn between $44,500.00 and $81,800.00 per year, depending on experience, location, and employer.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

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

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
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 are popular job titles related to Utilization Review Manager jobs in Florida? For Utilization Review Manager jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Florida look for? The top searched job categories for Utilization Review Manager jobs in Florida are:
What cities in Florida are hiring for Utilization Review Manager jobs? Cities in Florida with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $68,012 per year, or $32.7 per hour.

Manager, Utilization Review

Health Business Solutions LLC

Cooper City, FL • Remote

Full-time

Re-posted 5 days ago

Job description

The Manager, Utilization Review is responsible for overseeing the daily operations of the Utilization Review for one of our clients and leading a team of Utilization Review Nurses. This role involves ensuring efficient care coordination, managing healthcare costs, and maintaining high-quality patient care standards. The Manager, Utilization Review will collaborate with various healthcare professionals to improve patient outcomes and streamline care processes.

Key Responsibilities:

1. Leadership and Team Management:

• Supervise and mentor a team of Utilization Review Nurses, providing guidance and support to ensure excellent performance.

• Foster a collaborative and cohesive work environment within the department.

• Conduct regular staff meetings, performance evaluations, and staff development activities.

2. Care Coordination and Oversight:

• Oversee the development and implementation of individualized care plans for patients.

• Collaborate with the healthcare team to ensure coordinated and efficient patient care across different healthcare settings.

• Monitor and assess the appropriateness of care plans and resource utilization.

3. Quality Improvement:

• Implement and monitor quality improvement initiatives to enhance patient outcomes and compliance with healthcare regulations.

• Analyze data and metrics to identify areas for improvement in care coordination processes.

4. Budget Management:

• Manage the department's budget and resource allocation efficiently while maintaining high-quality patient care.

• Collaborate with finance and administrative teams to optimize resource utilization.

5. Staff Development:

• Provide ongoing training and education to Utilization Review Nurses to keep them updated on best practices and regulatory changes.

• Encourage professional growth and development within the department.

6. Patient Advocacy:

• Serve as a patient advocate, ensuring that patients' needs and preferences are addressed throughout their healthcare journey.

• Participate in complex case reviews and offer guidance on challenging patient cases.

7. Documentation and Compliance:

• Ensure accurate and timely documentation of patient records, care plans, and progress notes in accordance with regulatory standards.

Qualifications:

• Current RN (Registered Nurse) license. Compact or Multi-State License strongly preferred.

• Bachelor's degree in Nursing (BSN) required Masters (MSN) preferred.

• Previous experience in case management or care coordination, with at least 2 years in a leadership role.

• Strong clinical assessment and critical thinking skills.

• Excellent communication and interpersonal skills.

• Knowledge of healthcare regulations, insurance processes, and quality improvement methodologies.

• Proficiency in electronic health records (EHR) and healthcare software.

• Dedication to patient-centered care and a commitment to ethical practice.

If you are an experienced and visionary nurse leader who is passionate about improving patient care and outcomes, we invite you to apply for the Utilization Review Nurse Manager position. Join our team and lead the way in optimizing patient care. Apply today!


Health Business Solutions (HBiz) is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.

HBiz complies with all applicable employment laws for remote and multi-state hiring and provides reasonable accommodations as required by law.


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