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

HC&N Healthcare Solutions

MDS Coordinator RN

Miami, FL · On-site

$35.75 - $43/hr

Responsible for timely and accurate completion of Utilization Review and Triple Check. * Serves on ... Registered Nurse with current, active license in state of FL * Minimum two (2) years of clinical ...

Fabergent

Clinical Care Reviewer

Doral, FL · On-site

Current FL RN licensure Registered Nurse graduated from an accredited Diploma, Associates Degree or ... ER, ICU) Experience with Utilization Review and/or Prior Authorization Familiar with Interqual ...

Community Medical Group

APRN

Miami, FL · On-site

$106K - $145K/yr

As an APRN, you will play a vital role in delivering high-quality, comprehensive care to our ... Support utilization review and billing documentation processes * Provide clinical guidance and ...

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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.

MDS Coordinator RN

HC&N Healthcare Solutions

Miami, FL • On-site

$35.75 - $43/hr

Full-time

Re-posted 17 days ago

Job description

MDS Coordinator - RN

A skilled nursing facility is looking for a talented and hard-working MDS Coordinator to join our ever-growing team.

Job description

  • Oversees accurate and thorough completion of the Minimum Data Set (MDS), Care Area Assessments (CAA's) and Care Plans, in accordance with current federal and state regulations and guidelines that govern the process
  • Demonstrates an understanding of MDS requirements related to varied payers including Medicare, Managed Care and Medicaid
  • Facilitates the Care Management Process engaging the resident, IDT and family in timely identification and resolution of barriers to discharge resulting in optimal resident outcomes and safe transition to the next care setting
  • Analyzes QI/QM data in conjunction with the Director of Nursing Services to identify trends on a monthly basis.
  • Responsible for timely and accurate completion of Utilization Review and Triple Check.
  • Serves on, participates in, and attends various other committees of the Facility/Community (e.g., Quality Assessment and Assurance) as required, and as directed by their supervisor and Administrator.

Qualifications:

  • Registered Nurse with current, active license in state of FL
  • Minimum two (2) years of clinical experience in a health care setting
  • Minimum of one (1) year of experience in a long term care setting
  • Prior experience as an MDS coordinator preferred

Benefits Offered: Great benefits

Salary Range: Based experience

An Equal Opportunity Employer