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

HandsOn Global Management

Be Seen First

UM Review Nurse

Tampa, FL · Remote

$36 - $40/hr

Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews ... Licensed RN or LPN required. * Minimum of two to three years varied clinical experience required.

Acadia Healthcare

Utilization Specialist

Wesley Chapel, FL · On-site

$55 - $75/hr

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

The ideal candidate will have an active RN license and 3-5 years of workers' compensation and/or catastrophic case management experience. Experience with DME, utilization review, EMRs, care ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

The ideal candidate will have an active RN license and 3-5 years of workers' compensation and/or catastrophic case management experience. Experience with DME, utilization review, EMRs, care ...

Paradigm

Clinical Navigator

Tampa, FL · On-site

$73K - $88K/yr

The ideal candidate will have an active RN license and 3-5 years of workers' compensation and/or catastrophic case management experience. Experience with DME, utilization review, EMRs, care ...

VITAS Healthcare

Registered Nurse (RN)

Lakeland, 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)

Lakeland, 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 ...

Bileddo Associates

Care Manager Homecare RN

Tampa, FL

$55K - $104K/yr

... utilization. Assesses physical, functional, psychosocial, social, spiritual, educational ... Reviews patient history and physical, diagnostics and laboratory data Reviews available information ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for utilization review rn in Lakeland, FL is $39.42, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.29 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 Lakeland, FL?

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

What are popular job titles related to Utilization Review Rn jobs in Lakeland, FL?

For Utilization Review Rn jobs in Lakeland, FL, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Lakeland, FL look for?

The top searched job categories for Utilization Review Rn jobs in Lakeland, FL are:

What cities near Lakeland, FL are hiring for Utilization Review Rn jobs?

Cities near Lakeland, FL with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Lakeland, FL as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $81,986 per year, or $39.4 per hour.

Case Manager, RN- Utilization Review

Tampa General Hospital (TGH)

Tampa, FL • On-site

Full-time

Posted 26 days ago

Tampa General Hospital rating

7.4

Company rating: 7.4 out of 10

Based on 163 frontline employees who took The Breakroom Quiz

344th of 1,065 rated hospitals

Job description

Under the general supervision of the Utilization Management Manager and in accordance with established policies, professional guidelines, and CMS Conditions of Participation for Utilization Review, the Utilization Management Nurse (UMN) ensures patients are assigned to the most appropriate level of care based on nationally recognized admission and continued stay criteria. The UMN performs admission, concurrent, and retrospective utilization reviews using clinical expertise and medical necessity screening tools; evaluates appropriateness of services and expected length of stay; and supports timely authorization determinations through collaboration with payers. The UMN works closely with physicians, Care Coordinators, Resource Center Associates, Nursing, and leadership to address cases where criteria are not met, escalate concerns to the Physician Advisor or appropriate medical leadership, participate in denial management, and support efficient patient flow. All duties are performed in alignment with Tampa General Hospital's mission, vision, values, and quality standards.
Technical Knowledge, Skills, and Abilitie
  • In-depth knowledge of utilization review processes, nationally recognized medical necessity criteria (e.g., InterQual or similar), and appropriate level-of-care determination.
  • Ability to apply clinical nursing knowledge to evaluate the appropriateness of admissions, continued stays, diagnostic testing, and treatment plans.
  • Knowledge of Medicare, Medicaid, managed care, and commercial payer requirements, including authorization, denial, and appeal processes.
  • Ability to identify cases where criteria are not met, analyze complex clinical and payer-specific issues, and escalate appropriately through physician, Physician Advisor, and leadership channels.
  • Strong communication skills with the ability to effectively collaborate with physicians, payers, interdisciplinary teams, and leadership to justify medical necessity, resolve denials, and support patient flow.
  • Proficiency in accurate, timely documentation of utilization reviews, payer communications, and determinations using electronic medical records and utilization management systems.

Essential Function
  • Conducts initial admission reviews using nationally accepted criteria to determine medical necessity, appropriate level of care, and patient status designation.
  • Performs concurrent and ongoing reviews to assess continued stay, appropriateness of services, and expected length of stay, ensuring alignment with clinical presentation and regulatory requirements.
  • Reviews retrospective cases and participates in denial management, including preparation of clinical documentation and support for appeals in collaboration with Physician Advisors and Appeals teams, when appropriate.
  • Collaborates with payers regarding medical necessity determinations, authorization decisions, and continued stay reviews for inpatient admissions and clinical services.
  • Identifies cases where admission or continued stay criteria are not met and communicates findings with the attending physician, escalating to the Physician Advisor or appropriate medical leadership as needed.
  • Works closely with Care Coordinators, Resource Center Associates, Nursing, Physicians, and leadership to support appropriate patient status, care progression, and effective utilization of hospital resources.
  • Promotes appropriate status designation and medical necessity decisions to support timely patient movement and efficient hospital throughput.
  • Documents all utilization reviews, payer interactions, authorization decisions, clinical findings, and determinations in accordance with departmental standards, regulatory requirements, and organizational policies.
  • Contributes to departmental and organizational performance improvement initiatives related to utilization management, denial reduction, regulatory compliance, and quality outcomes.
  • Performs all duties in accordance with CMS Conditions of Participation, hospital utilization review plans, confidentiality standards, and professional nursing and utilization management guidelines.
  • Proficiency in Microsoft applications, including Outlook, Teams, Word, and Excel, to support clinical documentation, communication, data tracking, reporting, and interdisciplinary collaboration in a remote or hybrid work environment.

Qualifications
  • Licensed as a Registered Nurse in the state of Florida
  • Three (3) years as a practicing RN.
  • Utilization Management experience preferred

What Tampa General Hospital employees say

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About Tampa General Hospital

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Tampa General Hospital was named the #1 hospital in Tampa Bay by U.S. News & World Report, 2020-2021, and recognized as one of America's Best Hospital's in five medical specialties: Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Nephrology, and Orthopedics. Tampa General Hospital has been designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC), the highest recognition for nursing excellence, for the fourth consecutive time - an accomplishment that fewer than one percent of hospitals nationwide have earned. TGH is accredited by The Joint Commission and was awarded disease-specific certification in five medical specialties. TGH is also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). *Air transport provided by Metro Aviation, Inc.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Tampa, FL, US

Year founded

1927

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