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Utilization Review Rn Jobs in Clermont, FL (NOW HIRING)

VITAS Healthcare

Registered Nurse (RN)

Mount Dora, FL · On-site

Registered Nurse, RN, develops and achieves professional growth goals and objectives personally and per Team Manager reviews b. Registered Nurse, RN, responsible for attending orientation and ...

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Utilization Review Rn information

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$19

$37

$61

How much do utilization review rn jobs pay per hour?

As of Aug 4, 2026, the average hourly pay for utilization review rn in Clermont, FL is $37.72, according to ZipRecruiter salary data. Most workers in this role earn between $29.81 and $43.32 per hour, depending on experience, location, and employer.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are popular job titles related to Utilization Review Rn jobs in Clermont, FL? For Utilization Review Rn jobs in Clermont, FL, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Clermont, FL look for? The top searched job categories for Utilization Review Rn jobs in Clermont, FL are:
What cities near Clermont, FL are hiring for Utilization Review Rn jobs? Cities near Clermont, FL with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Clermont, FL as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $78,459 per year, or $37.7 per hour.

Utilization Review Manager (On-site) (279)

LIFESTREAM BEHAVIORAL CENTER

Leesburg, FL • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 25 days ago

Job description

Job Purpose:
- The Utilization Review Manager - RN at LIFESTREAM BEHAVIORAL CENTER is responsible for overseeing the utilization review process to ensure that patient care services are delivered efficiently and effectively. This role involves collaborating with healthcare providers to optimize patient outcomes and resource utilization while ensuring compliance with regulatory and accreditation standards.
Key Responsibilities:
- Lead and manage the utilization review team to ensure timely and accurate assessments of patient care plans.
- Develop and implement utilization review policies and procedures in accordance with organizational and regulatory requirements.
- Collaborate with clinical staff to review patient cases and determine the appropriateness of care and services provided.
- Analyze data and prepare reports on utilization trends, recommending improvements to enhance patient care and resource management.
- Serve as a liaison between the healthcare team and insurance providers to facilitate authorizations and resolve any coverage issues.
- Provide education and training to staff on utilization review processes and best practices.
- Ensure compliance with all relevant regulations, standards, and guidelines related to utilization management.
- Participate in quality improvement initiatives to enhance the efficiency and effectiveness of patient care delivery.

Required Education:
- Current Registered Nurse (RN) license in the state of Florida or Florida Licensure as a clinical social worker, mental health counselor, or marriage and family therapist. Master's degree preferred.
Required Experience:
- Minimum of 3 years of clinical nursing experience, social work, or psychology preferably in a behavioral health or psychiatric setting.
- Minimum of 3 years of experience in utilization review or case management within a hospital and/or behavioral health.
- 3+ years of supervisory or management experience required.
Required Skills and Abilities:
- Strong understanding of utilization review processes and healthcare regulations.
- Excellent analytical skills to assess patient care needs and determine appropriate levels of service.
- Proficient in electronic medical records (EMR) systems and healthcare management software.
- Exceptional communication and interpersonal skills to collaborate with healthcare providers, patients, and insurance companies.
- Ability to lead and motivate a team, ensuring compliance with organizational policies and procedures.
- Detail-oriented with strong organizational skills to manage multiple cases simultaneously.
- Ability to handle sensitive information with confidentiality and professionalism.

LifeStream Benefits

  • Health/Dental/Vision Insurance
  • Short Term Disability
  • Pension Plan
  • 403(b)
  • PTO  (Over 4 weeks your 1st year!)
  • Flexible Work Schedules
  • Tuition Reimbursement Program
  • Free Telehealth Services
  • HRSA
  • And More!

Important Notice 
As part of our hiring process and in compliance with Section435.04, Florida Statutes, certain positions require a Level2 background screening. Employment offers are contingent upon meeting applicable requirements. For more details on Level 2 background screening requirements, please visit: Florida Care Provider Background Screening Clearinghouse  

LifeStream is an equal opportunity employer and does not discriminate against any applicant based on age, citizenship, color, covered veteran status, disability, gender identity, genetic information, marital status, race, religion, sex, sexual orientation, or other protected status in accordance with applicable federal, state, and local laws.  

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