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Utilization Review Manager Jobs in New Port Richey, FL

BayCare

Physician Advisor - UM MSQ

Tampa, FL · On-site

Is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. * Develop expertise on matters ...

Dane Street, LLC

Chiropractor

Tampa, FL · On-site

$72K - $88K/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

Dane Street, LLC

Chiropractor

Tampa, FL · On-site

$72K - $88K/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

Dane Street, LLC

Chiropractor

Tampa, FL · On-site

$72K - $88K/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

GQR Healthcare

Travel RN Case Management

Largo, FL · On-site

$1.8K - $1.9K/wk

Case Management/Utilization Review Shift: Day Shift Details: null Day Job Type: Travel *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible ...

SRI Management

Home Health Clinical Manager

Tampa, FL · On-site

DUTIES The Clinical Manager (CM), in accordance with policies and standards established by the ... Oversees all CQI and utilization review activities. Assists in Agency evaluation activities.

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in New Port Richey, FL

Utilization Review Manager information

See New Port Richey, FL salary details

$34.7K

$81.1K

$149.2K

How much do utilization review manager jobs pay per year?

As of Jul 27, 2026, the average yearly pay for utilization review manager in New Port Richey, FL is $81,063.00, according to ZipRecruiter salary data. Most workers in this role earn between $53,000.00 and $97,500.00 per year, depending on experience, location, and employer.

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, and why are they important?

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 New Port Richey, FL? The most popular types of Utilization Review jobs in New Port Richey, FL are:
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What cities near New Port Richey, FL are hiring for Utilization Review Manager jobs? Cities near New Port Richey, FL with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in New Port Richey, FL as of July 2026, with employment types broken down into 79% Full Time, 20% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $81,063 per year, or $39 per hour.
Utilization Review Nurse

Utilization Review Nurse

Healthcare Support Staffing

Tampa, FL

$29 - $30/hr

Full-time

Posted 3 days ago

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


Healthcare Support logo

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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