Tampa, FL · On-site
$29 - $30/hr
... Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews] Additional Information Shift: Monday - Friday 8:00am - 5:00pm This is an immediate contract opening! Pay range $29.00 ...
Tampa, FL · On-site
$29 - $30/hr
... Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews] Additional Information Shift: Monday - Friday 8:00am - 5:00pm This is an immediate contract opening! Pay range $29.00 ...
The Utilization Review Specialist Senior responsibilities include: * Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care ...
The Utilization Review Specialist Senior responsibilities include: * Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care ...
Tampa, FL · On-site +1
The UMN performs admission, concurrent, and retrospective utilization reviews using clinical expertise and medical necessity screening tools; evaluates appropriateness of services and expected length ...
Tampa, FL · On-site +1
The UMN performs admission, concurrent, and retrospective utilization reviews using clinical expertise and medical necessity screening tools; evaluates appropriateness of services and expected length ...
$59K - $76K/yr
The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...
$59K - $76K/yr
The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...
Tampa, FL · On-site
$59K - $76K/yr
The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...
Tampa, FL · On-site
$59K - $76K/yr
The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...
Tampa, FL · On-site
$28 - $32/hr
Utilization Review/Outpatient Care RN Are you an experienced Registered Nurse with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the ...
Tampa, FL · On-site
$28 - $32/hr
Utilization Review/Outpatient Care RN Are you an experienced Registered Nurse with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the ...
Tampa, FL · On-site
$59K - $76K/yr
The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...
Tampa, FL · On-site
$59K - $76K/yr
The ideal candidate performs utilization review on workers' compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in ...
Utilization Review * Discipline: RN * Duration: Ongoing * 36 hours per week * Shift: 12 hours, days * Employment Type: Staff Under the general supervision of the Utilization Management Manager and in ...
Utilization Review * Discipline: RN * Duration: Ongoing * 36 hours per week * Shift: 12 hours, days * Employment Type: Staff Under the general supervision of the Utilization Management Manager and in ...
Reviewing medical necessities and medical record documentation and communicating health concerns for obtaining information. * Calls insurance companies to obtain precertification or concurrent with ...
Reviewing medical necessities and medical record documentation and communicating health concerns for obtaining information. * Calls insurance companies to obtain precertification or concurrent with ...
Review admissions, continued stay, and level-of-care decisions in coordination with providers * Support the facility's utilization management program and related reporting requirements * Collaborate ...
Quick apply
Review admissions, continued stay, and level-of-care decisions in coordination with providers * Support the facility's utilization management program and related reporting requirements * Collaborate ...
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Wesley Chapel, FL · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Wesley Chapel, FL · On-site
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Tampa, FL · On-site
$19 - $26/hr
The Utilization Review LPN is responsible for the pre-certification of determined procedures utilizing the organizations Plan approved criteria. The position helps manage healthcare costs by ...
Tampa, FL · On-site
$19 - $26/hr
The Utilization Review LPN is responsible for the pre-certification of determined procedures utilizing the organizations Plan approved criteria. The position helps manage healthcare costs by ...
Be Seen First
Tampa, FL · Remote
$36 - $40/hr
Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews (UR) using evidence-based guidelines, policies and nationally recognized clinical criteria, and ...
Quick apply
Be Seen First
Tampa, FL · Remote
$36 - $40/hr
Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews (UR) using evidence-based guidelines, policies and nationally recognized clinical criteria, and ...
General Purpose of Job To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers to facilitate ...
General Purpose of Job To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers to facilitate ...
$18.59 - $22.35
2% of jobs
$22.35 - $26.11
9% of jobs
$28.68 is the 25th percentile. Wages below this are outliers.
$26.11 - $29.87
21% of jobs
The median wage is $32.91 / hr.
$29.87 - $33.63
23% of jobs
$33.63 - $37.39
13% of jobs
$40.31 is the 75th percentile. Wages above this are outliers.
$37.39 - $41.15
10% of jobs
$41.15 - $44.91
8% of jobs
$44.91 - $48.67
5% of jobs
$48.67 - $52.43
5% of jobs
$52.43 - $56.19
2% of jobs
$56.19 - $59.95
2% of jobs
$18
$36
$59
A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.
A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.
To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.
The most popular types of Utilization Review jobs in Brandon, FL are:
For Utilization Review jobs in Brandon, FL, the most frequently searched job titles are:
The top searched job categories for Utilization Review jobs in Brandon, FL are:
Cities near Brandon, FL with the most Utilization Review job openings:
$29 - $30/hr
Full-time
Re-posted 28 days ago
Why You Should Work For Us:
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
You, as the Nurse Reviewer will be held responsible for the comprehensive review of the medical information for the assigned medical record review and completion of all paperwork, communication and data entry involved. Reviews will include quality of care, medical necessity; DRG validation, focused, readmission, Emergency Medical Treatment and Active Labor Act [EMTALA], and all others are required by contract. Communicates with the Medicare beneficiary/family members, healthcare providers and/or practitioners as needed during the course of the identified review.
Essential Duties:
Maintains current knowledge of the QIO contract, QIO Manual, SDPS Memorandums and Healthcare Communities Website to locate and apply up to date rules and protocols
Recognizes barriers to completing work and uses clinical judgment to determine when to seek assistance from the Review Supervisor
Communicates with the providers/practitioners via mail or phone regarding the need for clarification of requests and information provided in the correspondence letters.
Responds in a timely manner to the providers and/or practitioners if there is a request for information or assistance in order to facilitate the completion of the assigned medical record reviews.
Applies knowledge and expertise, analytical skills, critical thinking and business acumen to best meet customer needs.
Communicates with Medicare beneficiary via mail or phone as needed
Responds in a timely manner to the beneficiary if there is a request for information
Frequently seeks and accepts feedback with regards to the review process; listens actively; maintains frequent and open communication.
Collaborates to accomplish common goals to include accurate medical assessment of the beneficiary complaint and accurate Quality of Care Reviews.
Recommend actions that may increase quality /productivity related to the review process.
Communicates the current status of workload and availability for additional assignments
Collaborates with the KEPRO team to identify additional process improvements that support enhanced beneficiary satisfaction and overall improvement of heal care.
Collaborates with the KEPRO staff to support all contract requirements and identify additional contract improvements.
Active RN or LPN Licensure
Graduate from an accredited School of Nursing or college
3+ years of clinical experience within any healthcare setting [Acute Care, Inpatient, Outpatient, etc]
Quality Review experience [Medical Necessity, Utilization Review/Management, HEDIS, Chart Auditing, Medical Record Reviews]
Shift: Monday - Friday 8:00am - 5:00pm
This is an immediate contract opening!
Pay range $29.00 - $30.00/hr), salary negotiated based on relevant experience
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Recruiting and staffing services
201 - 500 Employees
Maitland, FL, US
2003
