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

RN Cancer Guides

Oncology Nurse Advocate

Inverness, FL · On-site

Current Florida RN or NP Preferred: BSN or MSN, Case Management Certification, utilization review experience Knowledge/Skills/Abilities * Strong computer skills, including Microsoft Office * Must be ...

RN Cancer Guides

Oncology Nurse Advocate

Inverness, FL · On-site

Current Florida RN or NP Preferred: BSN or MSN, Case Management Certification, utilization review experience Knowledge/Skills/Abilities * Strong computer skills, including Microsoft Office * Must be ...

UHS

Admissions RN - PRN

Ocala, FL · On-site

$63K - $86K/yr

... RN will review packets, accept and admit patients. This position requires a person to work with ... utilization review, marketing, and nursing. The Vines' Admissions department is an exciting ...

UHS

Admissions RN - PRN

Ocala, FL

$63K - $86K/yr

... RN will review packets, accept and admit patients. This position requires a person to work with ... utilization review, marketing, and nursing. The Vines' Admissions department is an exciting ...

UHS

ADMISSIONS RN - FT Nights

Ocala, FL · On-site

$63K - $86K/yr

... utilization review, marketing, and nursing. This position also qualifies for our $5,000.00 ... With 1 in 5 adults suffering from a mental illness, the Admissions RN must be able to adapt and ...

UHS

ADMISSIONS RN - FT Nights

Ocala, FL · On-site

$63K - $86K/yr

... utilization review, marketing, and nursing. This position also qualifies for our $5,000.00 ... With 1 in 5 adults suffering from a mental illness, the Admissions RN must be able to adapt and ...

UHS

ADMISSIONS RN - FT Nights

Ocala, FL · On-site

$63K - $86K/yr

... utilization review, marketing, and nursing. This position also qualifies for our $5,000.00 ... With 1 in 5 adults suffering from a mental illness, the Admissions RN must be able to adapt and ...

UHS

ADMISSIONS RN - FT Nights

Ocala, FL

$63K - $86K/yr

... utilization review, marketing, and nursing. This position also qualifies for our $5,000.00 ... With 1 in 5 adults suffering from a mental illness, the Admissions RN must be able to adapt and ...

UHS

Admissions RN- FT (Day)

Ocala, FL · On-site

$63K - $86K/yr

... utilization review, marketing, and nursing. This position also qualifies for our $5,000.00 ... With 1 in 5 adults suffering from a mental illness, the Admissions RN must be able to adapt and ...

UHS

Admissions RN- FT (Day)

Ocala, FL · On-site

$63K - $86K/yr

... utilization review, marketing, and nursing. This position also qualifies for our $5,000.00 ... With 1 in 5 adults suffering from a mental illness, the Admissions RN must be able to adapt and ...

UHS

RN Supervisor- FT Days

Ocala, FL · On-site

Familiarity with ICD-10 coding, utilization review, case management, and discharge planning ... Valid RN license in the state of Florida required; additional certifications such as Basic Life ...

UHS

RN Supervisor- FT Days

Ocala, FL · On-site

Sign-on Bonus: $$7,500.00 Overview of Position - Nurse Supervisor (RN) - Night Shift The Nursing ... Familiarity with ICD-10 coding, utilization review, case management, and discharge planning ...

Encompass Health Corporation

Case Manager II

Ocala, FL · On-site

The CCM performs ongoing utilization review and acts as a liaison to the payor while assuring that ... RN, SW, OT, PT, ST, and Rehabilitation Counseling). - If licensure is required for his/her ...

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Utilization Review Rn information

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$39

$64

How much do utilization review rn jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for utilization review rn in Ocala, FL is $39.30, according to ZipRecruiter salary data. Most workers in this role earn between $31.06 and $45.14 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 Ocala, FL?

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Ocala, FL as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $81,736 per year, or $39.3 per hour.

RN, Utilization Management | Utilization Management

UF Health

The Villages, FL

Full-time

Re-posted 9 days ago

Job description

Overview

Join an onsite clinical team focused on ensuring the right care at the right time for every patient.

???? Work Style: Onsite
???? Location: The Villages, FL
???? FTE: Full-Time (1.0 FTE)
????️ Schedule: Monday – Friday (occasional weekends required)

Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.

Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement.

Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.


Responsibilities

Key Responsibilities

  • Evaluates patient medical records to ensure the necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers to ensure compliance with utilization management guidelines.
  • Supports the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
  • Communicates authorization decisions clearly and supports timely discharge planning.
  • Analyzes utilization data to identify trends and opportunities to improve care coordination.
  • Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications

Education & Experience:


Registered Nurse (RN) with a current Florida license required.

  • Three (3) years of critical care nursing experience, or
  • Five (5) years of medical-surgical nursing experience, or
  • Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications

  • Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
  • Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
  • Experience evaluating medical necessity and optimizing treatment plans.
  • Excellent communication skills with the ability to clearly convey authorization decisions.
  • Ability to analyze utilization data and support effective care coordination.
  • Strong organizational skills with the ability to manage multiple priorities simultaneously.
  • Ability to work independently and collaboratively with multidisciplinary teams.
  • Strong attention to detail and innovative problem-solving skills.
  • Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation:
Employees in this position will not operate vehicles for an assigned business purpose.

Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.

Licensure/Certification/Registration:

  • Registered Nurse (RN) with a current Florida license required.

Apply