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Utilization Review Manager Jobs in Miami, FL (NOW HIRING)

ChenMed

Physician Reviewer

Miami, FL · On-site

$204K - $292K/yr

ChenMed is seeking a Physician Reviewer to serve as the primary physician reviewer for Utilization Management (UM) cases. This role involves advising other physician reviewers, participating in daily ...

Independent Living Systems

Physician Reviewer

Miami, FL · On-site

Minimum of 3 years clinical experience in a managed care setting. * Strong knowledge of clinical guidelines, and healthcare regulations. Preferred Qualifications: * Experience in utilization review ...

Uloop Inc.

Medical Management Coordinator, RN

Miami, FL · On-site

$60 - $90/hr

Qualifications Minimum 2 years of experience with pre-authorization, utilization review/management, case management, care coordination, and/or discharge planning. Knowledge/Skills/Abilities ...

Dane Street, LLC

Chiropractor

Miami, FL · On-site

$73K - $89K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

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

Utilization Review Manager information

See Miami, FL salary details

$37.3K

$87K

$160.2K

How much do utilization review manager jobs pay per year?

As of Sep 5, 2026, the average yearly pay for utilization review manager in Miami, FL is $87,047.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,900.00 and $104,700.00 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 Miami, FL?

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

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

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

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

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

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

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

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Miami, FL as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 14% Part Time, and 1% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $87,047 per year, or $41.8 per hour.

Manager, Utilization Management

Independent Living Systems, llc

Miami, FL • On-site

$100 - $130/hr

Other

Re-posted 2 days ago

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Management Miami, FL, US

We are seeking a Manager, Utilization Management to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Manager, Utilization Management plays a vital role in overseeing the evaluation and authorization of healthcare services to ensure appropriate, cost-effective care delivery. This position is responsible for overseeing the utilization management process to ensure efficient and effective use of resources. The Manager, Utilization Management is also responsible for developing and implementing utilization management policies and procedures to ensure compliance with regulatory requirements and industry standards. The Manager, Utilization Management will lead a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate. The Manager, Utilization Management’s role is vital in ensuring that patients receive the highest quality of care while managing costs for the organization.

Minimum Qualifications:
  • Bachelor's degree in nursing, healthcare administration, or related field
  • 3 years of experience in utilization management or related field
  • Experience leading a team of utilization management professionals
  • Strong knowledge of regulatory requirements and industry standards
  • Relevant experience may substitute for the educational requirement on a year-for-year basis
Preferred Qualifications:
  • Master's degree in nursing, healthcare administration, or related field
  • Experience working in a managed care organization
  • Certification in utilization management or related field
Responsibilities:
  • Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
  • Lead and manage a team of utilization management personnel to review and authorize medical services, ensuring that they are medically necessary and appropriate.
  • Manage utilization management processes to ensure efficient and effective use of resources.
    • Utilize established utilization management guidelines to review and authorize medical services.
  • Ensure that medical services are medically necessary and appropriate.
  • Implement utilization management activities in accordance with established policies and procedures.
  • Ensure compliance with regulatory requirements and industry standards.
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