ZipRecruiter

Log In

1

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

Community Medical Group

APRN

Orlando, FL · On-site

Participate in the utilization review of the billing process. * Directly supervise the work of ... Must be licensed to practice medicine in the state of Florida as an APRN. * At least (5) years of ...

Solaris HealthCare Forest Lake

RN Unit Manager

Apopka, FL · On-site

$34.75 - $46/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 Forest Lake

RN Unit Manager

Apopka, FL · On-site

$34.75 - $46/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 Forest Lake

RN Unit Manager

Apopka, FL · On-site

$34.75 - $46/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 ...

UHS

UM COORDINATOR (PRN) - Weekdays

Orlando, FL

Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.

UHS

UM COORDINATOR (PRN) - Weekdays

Orlando, FL · On-site

Three (3) to five (5) years' experience in chart analysis and utilization review in the psychiatric and chemical dependency filed preferred. * Valid FL license, e.g., RN, LSCW, LMHC or LMFT preferred.

Solaris HealthCare College Park

RN Unit Manager

Orlando, FL · On-site

$37 - $49/hr

Now Hiring: RN Unit Manager! Full-Time | Monday-Friday, 8 AM-5 PM At Solaris HealthCare College ... and utilization review activities. * Participates in clinical risk identification, strategy ...

Acadia Healthcare

RN - Admissions Nights

Apopka, FL · On-site

Overview RN Admissions Night Shift opportunity at Orlando Behavioral Health * Night Shift * 7pm-7 ... utilization review processes to assure continuity for the most appropriate level of care for ...

New

Solaris HealthCare Waterman

RN Unit Manager

Tavares, FL

$34.50 - $45.75/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 Waterman

RN Unit Manager

Tavares, FL · On-site

$34.50 - $45.75/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 ...

next page

Showing results 1-20

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 Jul 20, 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 to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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 make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 July 2026, with employment types broken down into 6% As Needed, 82% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% In-person job distribution, with an average salary of $82,179 per year, or $39.5 per hour.
Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

Molina Healthcare

Orlando, FL • Remote

$26.41 - $43/hr

Full-time

Re-posted 20 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

133rd of 281 rated insurance

Job description

JOB DESCRIPTION 

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
Processes requests within required timelines. 
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
Requests additional information from members or providers as needed. 
Makes appropriate referrals to other clinical programs. 
Collaborates with multidisciplinary teams to promote the Molina care model. 
Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 
Recent hospital experience in an intensive care unit (ICU) or emergency room.

  • Utilization Management (UM) experience highly preferred. 

#PJHS3

#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $43 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Molina Healthcare logo

About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

FacebookTwitter

View All Molina Healthcare Jobs

Apply