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

SNI USA Inc

Registered Nurse (RN)

Jacksonville, FL · On-site

$35 - $43/hr

Review laboratory results, identify abnormalities, and notify patients or guardians with ... Active Registered Nurse (RN) license in the state of Florida * 3+ years of pediatric, outpatient ...

VITAS Healthcare

Registered Nurse (RN)

Macclenny, 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 ...

VITAS Healthcare

Registered Nurse (RN)

Macclenny, 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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Showing results 21-40

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

Utilization Review Rn information

See Jacksonville, FL salary details

$19

$39

$63

How much do utilization review rn jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for utilization review rn in Jacksonville, FL is $39.18, according to ZipRecruiter salary data. Most workers in this role earn between $30.96 and $45.00 per hour, depending on experience, location, and employer.

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.

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.

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.

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 case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $81,488 per year, or $39.2 per hour.

Clinical Review Nurse - Remote

ARC Group

Jacksonville, FL • Remote

Full-time

Re-posted 21 days ago

Job description

CLINICAL REVIEW NURSE - REMOTE
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
  • Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
  • Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
  • Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
  • May develop recommendations for further corrective action based on medical review findings.
  • May refer for review, or implement, corrective action related to medical review activities.
  • May process claims and complete project work in the appropriate computer system(s).

The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
  • Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
  • This may involve discussion with CMS leaders and leaders in the provider community.
  • Participate in special projects as assigned.

REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.