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

RN - Case - Perm ???? Tallahassee, FL Openings: 1 Shift: Evening coverage | 12:00 PM - 8:30 PM EST ... Leads and oversees case management operations, ensuring effective utilization review ...

Case Manager RN

Tallahassee, FL · On-site

$31.94 - $43.92/hr

The RN Case Manager performs utilization management reviews and communicates findings to third-party payors, evaluates observation patients for status appropriateness, and escalates medical necessity ...

Case Manager RN + $10K Sign-on

Tallahassee, FL · On-site

$31 - $43/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Case Manager RN | Tallahassee, FL Schedule: * Evening Shift: 12:00 PM - 8:30 PM EST * 1 weekend per ... Perform utilization reviews and communicate with payors Experience required: * Minimum 3 years of ...

RN Case Manager

Tallahassee, FL · On-site

$31.94 - $43.92/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

RN Case Manager Location: Tallahassee, FL Shifts/Schedule: Evenings (12pm-8:30pm) | Full-Time | ... Certification in Case Management, Nursing, or Utilization Review, preferred Compensation & Benefits:

RN Case Manager

Tallahassee, FL

$31.94 - $43.92/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Position: RN Case Manager - Tallahassee, FL Shifts/Schedule: Evenings (12pm-8:30pm) | Full-Time | ... Certification in Case Management, Nursing, or Utilization Review, preferred Compensation & Benefits:

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for utilization review rn in Tallahassee, FL is $40.16, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.11 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 popular job titles related to Utilization Review Rn jobs in Tallahassee, FL?

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

What job categories do people searching Utilization Review Rn jobs in Tallahassee, FL look for?

The top searched job categories for Utilization Review Rn jobs in Tallahassee, FL are:

What cities near Tallahassee, FL are hiring for Utilization Review Rn jobs?

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

Infographic showing various Utilization Review Rn job openings in Tallahassee, FL as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $83,541 per year, or $40.2 per hour.

Regional Quality Review Registered Nurse- Thomasville

Georgia

Thomasville, GA

$72K/yr

Full-time

Posted 17 days ago


Job description

Explore a World of Opportunity with the State of Georgia!

We are the force that drives Georgia!
Georgia State Government is a large enterprise, composed of various agencies and entities with a common goal to improve the lives of Georgia's more than 10 million citizens!
Join Team Georgia and impact lives everyday while receiving a robust benefits package designed for every stage of your career!

Job Title:

Regional Quality Review Registered Nurse- Thomasville

Job Requisition ID:

JR0000001883

Number of Openings:

1

Shift:

Not Applicable (United States of America)

Compensation Details:

$72,000.00

Job Description:

Job Title:Regional Quality Review Registered Nurse- Thomasville

Workplace: Thomasville, Ga.

Hybrid or Remote: Remote

Travel: Averages 5-10 travel days per month

Job Summary:

Job Description, Responsibilities, Standards, and Qualifications
Monitoring the health and safety of individuals transitioning out of state hospitals to community programs. Monitoring will occur in all environments where the individual receives services.
Completing the designated audit tools and/or assessments at scheduled times. The tools/assessments are completed through observations, interviews and record reviews aimed at assessing the quality of the environment, health, medical supports and community integration of the individual.
Evaluating person centered supports to determine whether they are consistent with best practices, which would lead toward the appropriate/desired person-centered outcomes.
Provide technical] assistance/education onsite during audit process.
Documenting all visits, assessments and follow-up actions appropriately.
Consulting and coordinating with Team Leader and members on findings.
Participating in bi-weekly quality review team meetings with Team members, Regional Office and State Office as needed.
Conducting follow-up visits for the purpose of providing recommendations, technical assistance, and consultation to remedy any identified issues or support needs not being met.
Following DBHDD corrective action protocol based on the cur assessed environment.
The Registered Nurse participates as a member of the interdisciplinary intake and evaluation teams of individuals making application to and seeking continuing developmental disability services.
Registered Nurse will provide nursing services which include reviewing and completing the level of care of individual support plans, writing assessments, updates, technical assistance, and consultation.
Assessments require conducting interviews with consumers, family members, legal guardians, care givers, and primary care physicians as needed.
Administration of health risk assessment tools and required for which training is provided.
Responsibilities include making clinical recommendations and proposed action plans to the individual support plan team that supports the personal goals of the individual and addresses their medical needs in the community setting.

Job Responsibilities & Performance Standards:
Performs comprehensive assessments of consumer's health care needs based on data collected through history, observation, or psychosocial examination, and analysis of diagnostic data.
Completes ongoing follow up of technical assistance for individuals with medical issues of who have transitioned to the community from state institutional hospitalization.
Performs Initial and Participant directed HRST assessments of individual's health care needs based on data collected through history, observation, basic physical and/or psychosocial examination, and analysis of diagnostic data. Completes Level of Care as needed based upon the collected data.
As a part of required technical assistance, observes directs individuals care activities by observing medications, observing and recording patient responses and medication side effect (s); makes rounds and recommends interventions/treatments.
Consults and coordinates with health care team members to assess, plan, implement and evaluate client care plans.
Provides customer services to various individuals that we serve, as well as family members, care givers, and support persons.
Analyzes problems by evaluating available information and resources; develops effective, viable solutions to problems.
Participates in individualized and comprehensive plans of care consistent with assessment, physicians'/clinicians' treatment plans, individuals' level of need and functional ability as needed.
Provides health education instruction to consumers on various health issues (e.g. treatments, selfcare, surgical procedures, etc.) Provide in-service training for staff.
Assess individuals, health problems and needs, develop and implement nursing care plans, and maintain medical records.
Advise clients on health maintenance and disease prevention or provide case management.
Provides clear and accurate information to consumers, families, providers regarding diagnosis, treatment plan, discharge plan, and/or preventive care according to individualized health needs.
Responds appropriately to inquiries.
Communicates with agency personnel, service providers, support coordinator and other interested parties to coordinate efforts, resolve operational problems and improve quality of consumer care.
Works cooperatively with agency personnel, services providers, support coordinators, and other individuals involved in the care and services provided to the consumer, in order to maximize the appropriateness, benefit and effectiveness of services.
Accurately identifies measures, evaluates and resolves deficiencies found in the consumer care process in a timely manner.
Other Duties As Assigned.

Preferred Qualifications:
A current, unrestricted Georgia license to practice as a Registered Professional Nurse/Licensed Practical Nurse and TWO years of professional experience in a mental health, developmental disabilities, and/or addictive diseases facility or community-based setting (for example, a DBHDD regional office, community service board, or private, public, state hospital) and one year of professional level experience in a role which included evaluating DD individuals and their services. Experience in total quality management of services provided to individuals. Master's degree in nursing. Experience working with developmentally disabled people. Familiarity with individuals with intellectual/developmental disabilities and common cooccurring health issues

For benefits information, please visit: https://careers.dbhdd.ga.gov/why-dbhdd/

Employment Requirements
To ensure the safety and wellbeing of our employees, individuals and communities we serve, certain positions within DBHDD may require evaluations, vaccinations, professional licensure and certifications. Licenses must be current and enable providers to practice within the State of Georgia.

The following are a listing of evaluations and vaccinations that may be required for employees, including those not involved with direct care:

  • Drug Screening
  • TB Evaluation
  • Annual Influenza*

*Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.


Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process.

This position is subject to close at any time once a satisfactory applicant pool has been identified.

FOR THIS TYPE OF EMPLOYMENT, STATE LAW REQUIRES A NATIONAL AND STATE BACKGROUND CHECK AS A CONDITION OF EMPLOYMENT.

Minimum Qualifications:

Associate degree in nursing from an accredited college or university and current Georgia license as a Registered Professional Nurse or Multistate license and more than (12) months of DBHDD Registered Nurse 1 experience.

Equal Employment Opportunity Employer

The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services.
Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department.