ZipRecruiter

Log In

1

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

Molina Healthcare

Care Review Clinician (RN)

Tampa, FL

$26.41 - $51.49/hr

Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...

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)

Kissimmee, 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 ...

next page

Showing results 1-20

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

Utilization Review Rn information

See Lakeland, FL salary details

$19

$39

$64

How much do utilization review rn jobs pay per hour?

As of Jul 28, 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.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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 make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 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 July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $81,986 per year, or $39.4 per hour.
Utilization Review/Outpatient Care RN

Utilization Review/Outpatient Care RN

Healthcare Support Staffing

Tampa, FL

$28 - $32/hr

Other

Posted 17 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

Job Title: Utilization Review/Outpatient Care RN

Are you an experienced Registered Nurse with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!


Position Summary:

As the Utilization Review/Outpatient Care RN, you would be responsible for reviewing and collecting medical information in order to determine medical necessity of services requested.


Hours for this Position: Monday-Friday daytime hours (40 hours/week)


Advantages of this Opportunity:

  • Pay $28-$32 per hour, negotiable based on experience
  • Work for a prominent Healthcare company who pride themselves on partnership, integrity, teamwork, and accountability
  • Be a part of a team who serves the full spectrum of member needs
  • Weekly deposit options
  • Great benefits offered


More Insight of Daily Responsibilities: 

  • Ensures that services provided to eligible members are within benefit plan 
  • Initiates and continues direct communication with health care providers involved with the care of the member 
  • Identifies appropriate clinical settings for services being requested
  • Identifies and refers cases appropriate for case management
  • Identifies potential quality of care issues and refers to Quality Department
  • Determines appropriate utilization management of services requested
Qualifications

What We Look For:

  • Clear and active RN license in state of FL
  • 2+ years of acute clinical/surgical position
  • Recent experience with utilization management
Additional Information

Interested in being considered in this position?

TAKE THE NEXT STEP! Click the green I'M INTERESTED button to send me your resume.

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

Social media

FacebookTwitter

View All Healthcare Support Jobs

Apply