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

Florida Blue

Concurrent Review Nurse

Jacksonville, FL · On-site

$71K - $115K/yr

Registered Nurse - State Licensure And/Or Compact State Licensure Florida * Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

... a Registered Nurse, and/or have a Bachelor's Degree in Social Work or Psychology or equivalent education and experience in Utilization Review/ Management. Has knowledge of regulatory and ...

UHS

PRN UTILIZATION REVIEW COORDINATOR

Jacksonville, FL · On-site

PRN Utilization Review Coordinator, including weekends $26-$37 This position is responsible for ... Qualifications Registered Nurse, LPN or Master's level Social Worker with experience in Utilization ...

UHS

PT UTILIZATION REVIEW COORDINATOR

Jacksonville, FL · On-site

PT Utilization Review Coordinator, including weekends $26-$37 This position is responsible for ... Qualifications Registered Nurse, LPN or Master's level Social Worker with experience in Utilization ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Jacksonville, FL

Utilization Review Rn information

See Jacksonville, FL salary details

$19

$38

$62

How much do utilization review rn jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization review rn in Jacksonville, FL is $38.38, according to ZipRecruiter salary data. Most workers in this role earn between $30.34 and $44.09 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 the most commonly searched types of Utilization Review Rn jobs in Jacksonville, FL? The most popular types of Utilization Review Rn jobs in Jacksonville, FL are:
What are popular job titles related to Utilization Review Rn jobs in Jacksonville, FL? For Utilization Review Rn jobs in Jacksonville, FL, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Jacksonville, FL look for? The top searched job categories for Utilization Review Rn jobs in Jacksonville, FL are:
What cities near Jacksonville, FL are hiring for Utilization Review Rn jobs? Cities near Jacksonville, FL with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Jacksonville, FL as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $79,822 per year, or $38.4 per hour.

Utilization Review Specialist (RN) - Remote

Concierge Home Care

Jacksonville, FL • On-site

$65K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

Utilization Review Specialist (RN) – Remote

$65K–$85K | OASIS & Coding Certified | Florida RN License Required

Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential


At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team.


This role is ideal for an RN with strong experience in OASIS, coding, QA, and home health documentation review who thrives in a fast-paced, remote environment.


Quick Highlights

✔ Fully Remote Position
✔ Salary: $65,000–$85,000 (based on years of experience)
✔ Florida RN License Required
✔ OASIS Certification Required
✔ Home Health Coding Certification Required
✔ Monday–Friday or Weekend Schedule Options
✔ Quarterly Bonuses & Incentives
✔ Full Benefits Package


What You’ll Do

  • Review home health clinical documentation for accuracy and compliance
  • Audit OASIS documentation and care plans
  • Ensure coding accuracy and reimbursement integrity
  • Collaborate with Branch Directors, Clinical Managers, and field clinicians
  • Support quality assurance and regulatory compliance initiatives
  • Maintain productivity while reviewing high-volume documentation


Qualifications

Required

  • Active Florida RN License (unencumbered)
  • OASIS Certification
  • Home Health Coding Certification
  • Minimum 2 years of Home Health experience
  • Strong knowledge of Medicare guidelines and home health regulations
  • Ability to work independently in a remote setting
  • Excellent attention to detail and organizational skills

Preferred

  • WellSky/Kinnser experience
  • SHP platform experience
  • Prior QA, Utilization Review, or Clinical Auditing experience


Schedule Options

Weekday Position

  • Monday–Friday
  • Occasional weekend rotation (1 weekend/month)


Benefits

  • Medical, Dental & Vision Insurance
  • Life Insurance
  • 401(k)
  • 3 Weeks PTO
  • Quarterly Bonus Opportunities
  • Employee Referral Program
  • Free CEUs
  • Data Plan Reimbursement
  • Career Growth Opportunities


Why Concierge Home Care?

At Concierge Home Care, our mission is simple: Caring for people who care for people.

We are committed to supporting our clinicians with strong leadership, flexibility, and opportunities for professional growth.


Still have questions? Text or call Delaine directly: (904) 463-3529

Apply in under 2 minutes.


Join a team that empowers you to practice at the top of your license while maintaining the flexibility and income potential you deserve.


Employment is contingent upon successful completion of an AHCA Level 2 background screening. For more information, please visit the Florida Care Provider Background Screening Clearinghouse.




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