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

Leon Medical Centers

Concurrent Review Nurse

Doral, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills

Leon Health Plan

Concurrent Review Nurse

Doral, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is ... Minimum of two (2) years of experience in clinical review or utilization management Language Skills

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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 6, 2026, the average hourly pay for utilization review rn in Miami, FL is $40.44, according to ZipRecruiter salary data. Most workers in this role earn between $31.97 and $46.44 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 Miami, FL?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Miami, FL as of August 2026, with employment types broken down into 89% Full Time, and 11% Contract. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $84,116 per year, or $40.4 per hour.

Utilization Review Registered Nurse

Healthcare Support Staffing

Sunrise, FL

Full-time

Re-posted 18 days ago

Job description

Company Description

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

Our expanding managed care company is seeking RNs for positions in concurrent review and prior authorizations for our Sunrise office. This is a M-F daytime (no holidays/no weekends) fulltime position. This position is specific to managed care case management and is an excellent opportunity to start a career with one of the country's leading HMO's. Prior Authorizations Nurse responsibilities include speaking with providers and handling authorizations for surgery and medical services.

Concurrent Review Nurse responsibilities include reviewing inpatient admissions to determine if patients meet criteria to be in the hospital.

Salary dependent upon experience -- typical range 60K-72K


Qualifications

*MUST be Florida-licensed Registered Nurse and live in Broward or Dade counties

*5 years minimum nursing experience

*Must have 2 years minimum experience in at least one of the following: utilization review from another managed care company; experience in a medical setting handling coordinating with insurance companies in obtaining prior authorizations; and/or experience working as a concurrent review nurse for a hospital *Strong computer and communication skills

*InterQual experience strongly preferred

*Understanding of Medicare and Medicaid guidelines preferred


Additional Information

-Salary range 60K-72K

-Excellent opportunity to begin a career with one of Florida's leading health plans with excellent benefits

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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

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