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

UnitiMed

RN Case Manager

Margate, FL

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

HC&N Healthcare Solutions

MDS Coordinator RN

Miami, FL

$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 ...

HC&N Healthcare Solutions

MDS Coordinator RN

Miami, FL

$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

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

Hialeah, FL

Advanced Practice Registered Nurse (APRN) APRNs diagnose and treat acute, episodic, or chronic ... Participate in the utilization review of the billing process. * Directly supervise the work of ...

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

Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Jun 10, 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.

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.

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 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 June 2026, with employment types broken down into 87% Full Time, 10% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $84,116 per year, or $40.4 per hour.

Case Manager RN - CMRN 0529 IS#01

NavitasPartners

Miami, FL • On-site

$31.94 - $43.92/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago

Job description

Job Title: Case Manager RN
Location: Tallahassee, FL 32310
Shift: Day Shift (8:00 AM - 4:30 PM EST)
Schedule: 1 weekend every 4 weeks
Position Type: Permanent

Compensation & Benefits: $31.94 - $43.92/hr (based on experience)

  • Sign-on bonus (case-by-case)
  • Relocation assistance (case-by-case)
  • Medical, dental, vision, PTO, retirement, tuition assistance

Job Summary:

  • Coordinate patient care plans focusing on medical necessity and discharge planning
  • Ensure efficient patient flow and compliance with healthcare regulations
  • Collaborate with care teams, patients, and payers

Key Responsibilities:

  • Perform medical and psychosocial assessments
  • Develop and manage care and discharge plans
  • Conduct utilization review and communicate with payers
  • Lead care coordination and team meetings
  • Monitor inpatient vs observation status
  • Identify and escalate care concerns
  • Facilitate safe discharge and transitions
  • Coordinate post-discharge services
  • Educate patients and families
  • Maintain accurate documentation

Required Qualifications:

  • Active RN license (FL or Compact; FL within 90 days)
  • 3+ years acute care Case Management experience OR clinical background (Med/Surg, ICU, ED, etc.)
  • Associate Degree in Nursing or Diploma
  • Ability to work in a fast-paced environment

Preferred Qualifications:

  • BSN preferred
  • Case Management or related certification
  • Experience in Home Health or Insurance Case Management
  • Strong knowledge of utilization review and discharge planning

For more details reach at Aditi.sharma@navitashealth.com or Call / Text at 516-587-6677.

About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided, and your salary will be discussed upfront.

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