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Utilization Review Manager Jobs in Homestead, FL

Sunshine State Health Plan

Medical Director

Miami, FL · On-site +1

$236K - $449K/yr

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

NTT DATA Services

BPO Clinical Review Specialist

FL · On-site

$76K/yr

Knowledge of utilization management and medical necessity review processes. * Understanding of NCQA standards, Medicaid regulations, and healthcare appeals requirements. * Strong analytical and ...

Hireez

Clinical Care Manager - Catholic Hospice

Miami, FL · On-site

$85 - $110/hr

... utilization review of continuous care and inpatient levels of care for all patients on the team ... nursing and management experience preferred. * Hospice nursing experience preferred. * • ...

NTT DATA Services

BPO Clinical Review Specialist

FL · On-site

$62K/yr

Knowledge of utilization management and medical necessity review processes. * Understanding of NCQA standards, Medicaid regulations, and healthcare appeals requirements. * Strong analytical and ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Homestead, FL

Utilization Review Manager information

See Homestead, FL salary details

$35.8K

$83.6K

$153.9K

How much do utilization review manager jobs pay per year?

As of Sep 6, 2026, the average yearly pay for utilization review manager in Homestead, FL is $83,610.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,700.00 and $100,600.00 per year, depending on experience, location, and employer.

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 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 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 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.

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.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

What are the most commonly searched types of Utilization Review jobs in Homestead, FL?

The most popular types of Utilization Review jobs in Homestead, FL are:

What are popular job titles related to Utilization Review Manager jobs in Homestead, FL?

For Utilization Review Manager jobs in Homestead, FL, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Homestead, FL look for?

The top searched job categories for Utilization Review Manager jobs in Homestead, FL are:

What cities near Homestead, FL are hiring for Utilization Review Manager jobs?

Cities near Homestead, FL with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Homestead, FL as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 16% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $83,610 per year, or $40.2 per hour.

Physician Pulmonology - Competitive Salary

ChenMed

Miami, FL

Other

Posted 6 days ago

ChenMed rating

8.4

Company rating: 8.4 out of 10

Based on 40 frontline employees who took The Breakroom Quiz

1st of 247 rated social care providers

Job description

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

    • Provides Delegated UM by covering the specified territories as assigned:
      • Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
    • Advises other physician reviewers.
    • Other duties as assigned and modified by manager.

 

KNOWLEDGE, SKILLS AND ABILITIES:

    • Excellent analytical and deductive reasoning skills
    • Good judgement and problem-solving skills
    • Professional and effective communication skills
    • Strong organizational skills
    • Written and verbal fluency in English
    • Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint

EDUCATION AND EXPERIENCE CRITERIA:

    • Graduate from accredited Medical School with a valid, unrestricted license is required
    • Completion of Pulmonology Fellowship
    • Board Certification – Pulmonology
    • Two (2) years’ experience in Hospital medicine preferred
    • At least one (1) year of utilization review experience preferred

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About ChenMed

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We're expanding healthcare equity across America. We're already in 15 states with 100+ medical centers. As a rapidly growing, physician-led organization, we have one central focus: rescue any and every senior from a healthcare system that has failed them. Our family of brands include Chen Senior Medical Center, JenCare Senior Medical Center, and Dedicated Senior Medical Center. Recently named a 2021 Best Places To Work and one of the only healthcare companies recognized in Fortune's 2020 "Change The World" list, ChenMed prides itself on creating a culture that enables career growth and promotes inclusion for all.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Miami, FL, US

Year founded

1985

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