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

InnovAge

In-Home Services RN | M - F | Days

Tampa, FL · On-site

$38.80 - $50.48/hr

Participates in utilization review of medical records as assigned. * Processes orders and notifies ... Current State issued Registered Nurses License * Current First Aid and BLS certifications are ...

Skilled Nursing Facility

MDS Coordinator

Clearwater, FL · On-site

$31.50 - $40.25/hr

Review and track Utilization Review (UR) sheets weekly to ensure alignment between clinical status ... Provide RN signature on MDS assessments as required to ensure regulatory compliance (if applicable)

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

The ideal candidate will have an active RN license and 3-5 years of workers' compensation and/or catastrophic case management experience. Experience with DME, utilization review, EMRs, care ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

The ideal candidate will have an active RN license and 3-5 years of workers' compensation and/or catastrophic case management experience. Experience with DME, utilization review, EMRs, care ...

Tjm Property Management

ADON/RN

Clearwater, FL · On-site

$90 - $115/hr

Utilization review * Public relations * Consultant services * Other tasks as detailed below ... a registered nurse in this state and receive required continuing education units for license ...

Eye Mountain Cares Llc

Registered Nurse (RN)

Odessa, FL · On-site

$30 - $35/hr

... review when the Nurse Manager's participation is required. · Must maintain required personnel ... Ideal Candidate · Retired or semi-retired Registered Nurses. · RNs currently working part-time. ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review rn in Tampa, FL is $39.96, according to ZipRecruiter salary data. Most workers in this role earn between $31.59 and $45.87 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 Tampa, FL?

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

What are popular job titles related to Utilization Review Rn jobs in Tampa, FL?

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Tampa, FL as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $83,111 per year, or $40 per hour.

LPN Charge Nurse/MDS Coordinator

TJM PROPERTY MANAGEMENT INC

Clearwater, FL • On-site

$31.50 - $40.25/hr

Other

Re-posted 5 days ago

Job description

We are seeking a highly skilled and detail-oriented MDS Coordinator (Must have active FL RN or LPN Nursing License) to join our healthcare team. The ideal candidate will possess comprehensive knowledge of the Minimum Data Set (MDS)/PDPM process, clinical documentation, and regulatory compliance standards. As an essential member of our interdisciplinary team, the MDS Coordinator will oversee the accurate collection, review, and submission of resident data to ensure optimal reimbursement, quality reporting, and compliance with federal and state regulations. This role offers an opportunity to contribute significantly to patient care quality and operational efficiency within a dynamic healthcare environment.
Responsibilities
  • Coordinate the comprehensive assessment and documentation of resident conditions in accordance with MDS guidelines, ensuring accuracy and completeness.
  • Collaborate with nursing staff, physicians, case managers, and other healthcare professionals to gather pertinent clinical information for MDS completion.
  • Review medical records, clinical documentation, and coding details-including ICD-10 codes-to support precise data entry and compliance with SNF Medicare and other payer requirements.
  • Ensure timely submission of MDS assessments in alignment with regulatory deadlines while maintaining adherence to state-specific regulations.
  • Utilize EMR (Electronic Medical Record) systems such as Point Click Care or similar to document assessments within the electronic health record (EHR)
  • Conduct ongoing education for staff on documentation improvement strategies, utilization management, and coding updates related to ICD coding systems.
  • Monitor quality metrics related to clinical documentation improvement (CDI), discharge planning, hospice care, and case management processes to optimize patient care outcomes.
  • Maintain strict compliance with HIPAA regulations while managing sensitive medical records and ensuring confidentiality throughout all documentation processes.

Qualifications
  • Proven experience in managed care settings or hospital environments with a strong understanding of inpatient and outpatient clinical workflows.
  • Extensive knowledge of Point Click Care, Simple LTC or similar EMR Systems
  • Familiarity with ICD-10 coding standards, DRG assignment, and utilization review processes.
  • Background in medical office administration or health information management with a focus on medical documentation review.
  • Strong understanding of SNF Medicare regulations, discharge planning procedures, and hospice care protocols.
  • Excellent organizational skills coupled with the ability to interpret complex medical terminology and physiology knowledge for accurate data collection.

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