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

Turning Point Plans

Clinical Review Nurse

Lake Mary, FL · On-site

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required * Comprehensive knowledge of ...

St. Francis Hospice

APRN

Titusville, FL · On-site

Responsibilities include participation in medical staff coverage rotation, clinical quality assurance, pharmacy and utilization review, and performance improvement activities. An APRN degree with an ...

Solaris HealthCare College Park

RN Unit Manager

Orlando, FL · On-site

$37 - $49/hr

... and utilization review activities. * Participates in clinical risk identification, strategy ... Education Current R.N. license required with experience in the long term care or working with the ...

Solaris Healthcare College Park

RN Unit Manager

Orlando, FL · On-site

$37 - $49/hr

... and utilization review activities. * Participates in clinical risk identification, strategy ... Education Current R.N. license required with experience in the long term care or working with the ...

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

Utilization Review Rn information

See Orlando, FL salary details

$19

$39

$64

How much do utilization review rn jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review rn in Orlando, FL is $39.51, according to ZipRecruiter salary data. Most workers in this role earn between $31.20 and $45.38 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.

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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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 Orlando, FL? The most popular types of Utilization Review Rn jobs in Orlando, FL are:
What are popular job titles related to Utilization Review Rn jobs in Orlando, FL? For Utilization Review Rn jobs in Orlando, FL, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Orlando, FL look for? The top searched job categories for Utilization Review Rn jobs in Orlando, FL are:
What cities near Orlando, FL are hiring for Utilization Review Rn jobs? Cities near Orlando, FL with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Orlando, FL as of August 2026, with employment types broken down into 92% Full Time, and 8% Part Time. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $82,179 per year, or $39.5 per hour.

UTILIZATION REV SPEC I

Aspire Health Partners

Orlando, FL • On-site

Other

Re-posted 21 days ago

Aspire Health Partners rating

4.8

Company rating: 4.8 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

UTILIZATION REV SPEC I
Behavioral Health Utilization Review Specialist I
Aspire Health Partners, Inc.
Make a Difference in Behavioral Health Care
At Aspire Health Partners, we are dedicated to transforming lives through compassionate, high-quality behavioral healthcare. As Florida's largest nonprofit behavioral health provider, we serve diverse populations across Central Florida and are committed to clinical excellence and meaningful impact.
We are currently seeking a Utilization Review Specialist to join our team and play a key role in ensuring our clients receive the care they need while supporting effective coordination with insurance providers.
Position Summary
In this role, you will coordinate and manage insurance utilization review activities for hospitalized clients. You'll work closely with clinical teams, insurance representatives, and internal departments to ensure timely authorizations, support treatment planning, and contribute to high-quality patient outcomes.
Key Responsibilities
  • Partner daily with the Access Center and/or Crisis Response Center (CRC) to identify clients needing utilization review
  • Communicate clinical information to insurance reviewers to secure authorizations and extended lengths of stay
  • Collaborate with attending psychiatrists on clinical assessments and treatment recommendations
  • Participate in interdisciplinary treatment team meetings to support care for managed care clients
  • Provide constructive clinical feedback to enhance service delivery and patient care
  • Ensure accurate authorization details are submitted to Patient Accounts for billing
  • Review client charts for potential denial issues and support appeal processes when needed
  • Maintain strict adherence to ethical standards, confidentiality, and organizational policies
Qualifications
Required:
  • High School Diploma or equivalent
  • Level II Background clearance- All Aspire Health Partners Internships and Careers require Level 2 clearance, with Aspire covering fingerprinting costs. Click https://info.flclearinghouse.c... to learn more.
  • Valid driver's license with an acceptable driving record per organizational guidelines
Preferred:
  • Experience in behavioral health, utilization review, or managed care environments
  • LPN or RN experience
  • Strong communication, documentation, and organizational skills
Why Join Aspire?
  • Mission-driven organization making a real impact in your community
  • Collaborative, team-focused work environment
  • Opportunities for growth and professional development
  • A role where your work directly supports quality care and patient outcomes

Equal Opportunity Employer
Aspire Health Partners is a drug-free workplace and an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will be considered without regard to race, color, religion, national origin, sex, age, disability, or veteran status.

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