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Utilization Review Rn Jobs in Vero Beach, FL (NOW HIRING)

Skilled Nursing Facility

MDS Coordinator

Port Saint Lucie, FL · On-site

$34.25 - $43.75/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)

Skilled Nursing Facility

MDS Coordinator

Port Saint Lucie, FL · On-site

$34.25 - $43.75/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)

Florida Jobs

REGISTERED NURSE

Port Saint Lucie, FL · On-site

$67K/yr

Review and follow-up on resident incidents or complaints. Count narcotics at beginning and end of ... Will ensure economical utilization of supplies and proper charging of items to residents' accounts.

NHC

RN Registered Nurse

Vero Beach, FL · On-site

Unencumbered current Registered Nurse license in the state where the HomeCare agency is located or ... For further information, please review the Know Your Rights notice from the Department of Labor.

State of Florida

REGISTERED NURSE

Port Saint Lucie, FL · On-site

$67K/yr

Review and follow-up on resident incidents or complaints. * Count narcotics at beginning and end of ... Will ensure economical utilization of supplies and proper charging of items to residents' accounts.

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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 6, 2026, the average hourly pay for utilization review rn in Vero Beach, FL is $37.26, according to ZipRecruiter salary data. Most workers in this role earn between $29.42 and $42.79 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 Vero Beach, FL?

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Vero Beach, FL as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $77,498 per year, or $37.3 per hour.

Utilization Review Coordinator

Port St. Lucie Hospital

Port Saint Lucie, FL

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 23 days ago

Job description

Utilization Review Coordinator

Location: Everwell Port St. Lucie Hospital, Inc

Position Summary

Everwell Port St. Lucie Hospital is seeking a detail-oriented Utilization Review Coordinator to coordinate insurance reviews, monitor patient authorizations, and support effective communication between the hospital, physicians, and insurance providers.

Key Responsibilities

  • Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.

  • Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.

  • Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.

  • Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.

  • Contacts physicians and primary Nurses for clarification of information as necessary.

  • Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.

  • Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.

  • Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.

  • Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.

  • Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.

  • Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.

  • Performs special projects or other related work as required or requested.

  • Shows ability to communicate in a clear and concise manner.                       

  • Demonstrates ability to work with others.

  • Adapt to changing situations or work assignments.

  • Demonstrates willingness to rotate to other areas of hospital within the limits of preparation and skill level.

  • Conform to uniform and dress code, personal hygiene and good grooming.

  • Wear and properly display name badge.                                                                 

  • Positively respond to guidance or counseling and attempts to benefit by it.

  • Adept in identifying potential problems within the department and seeks management guidance.

  • Demonstrates excellent organizational skills and originator of new ideas and methods.

  • Use verbal and non-verbal communication with others, i.e., courtesy, tone of voice, facial expressions, gestures, etc.

  • Demonstrates an understanding of and adherence to the Code of Conduct

  • Conduct reflects Oglethorpe’s values and a commitment to the Code of Conduct

Qualifications and Education

  • RN, LPN or Master's Level Clinician with experience

  • CPR Certification required

  • Minimum 2 years of healthcare experience preferred

  • Knowledge of utilization review processes and medical terminology

  • Experience working with insurance companies and behavioral health

    documentation preferred

  • Ability to use data collection techniques, and statistical computations.

  • Strong communication, organizational, and analytical skills

  • Familiarity with DSM criteria and healthcare compliance standards preferred

  • Thorough knowledge of effective and appropriate charting principles

    Work Environment

    • Primarily indoor, temperature-controlled healthcare environment

    • Collaborative team-focused setting

      Benefits

    • Medical, Dental and Vision insurance

    • 401K

    • PTO and Sick time

    This position requires a pre-employment Level 2 Background check: https://info.flclearinghouse.com