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Utilization Review Jobs in Brandon, FL (NOW HIRING)

GQR Global Markets

RN - Case Manager

Largo, FL · On-site

$1.8K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Largo, Florida Start Date: June 15, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $1829.21 ...

GQR

RN - Case Manager

Largo, FL · On-site

$1.8K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Largo, Florida Start Date: June 15, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $1829.21 ...

GQR Healthcare

Travel RN Case Management

Largo, FL · On-site

$1.8K - $1.9K/wk

Case Management/Utilization Review Shift: Day Shift Details: null Day Job Type: Travel *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office applications is strongly preferred. This role is well-suited for a forward-thinking clinical ...

paradigm

Clinical Navigator

Tampa, FL · Remote

$61K - $84K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office applications is strongly preferred. This role is well-suited for a forward-thinking clinical ...

Dane Street, LLC

Chiropractor

Tampa, FL · On-site

$72K - $88K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street, LLC

Chiropractor

Tampa, FL · On-site

$72K - $88K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street, LLC

Chiropractor

Tampa, FL · On-site

$72K - $88K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Paradigm

Clinical Navigator

Tampa, FL · On-site

$73K - $88K/yr

Experience with DME, utilization review, EMRs, care management platforms, and Microsoft Office applications is strongly preferred. This role is well-suited for a forward-thinking clinical ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Jobs in Brandon, FL

Utilization Review information

See Brandon, FL salary details

$18

$36

$59

How much do utilization review jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for utilization review in Brandon, FL is $36.74, according to ZipRecruiter salary data. Most workers in this role earn between $29.04 and $42.21 per hour, depending on experience, location, and employer.

What is a utilization review?

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.

What does a utilization review do?

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.

What are the key skills and qualifications needed to thrive in utilization review?

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.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Brandon, FL?

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

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

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

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

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

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

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

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Brandon, FL as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $76,419 per year, or $36.7 per hour.

Healthcare Svcs Review Nurse

Hillsborough County - Board of County Commissioners

Tampa, FL • On-site

$32.84 - $60.18/hr

Full-time

Posted 10 days ago

Job description


Salary: $32.84 - $60.18
Job Overview
Coordinate and perform quality monitoring of services that provide care to the indigent citizens of the County enrolled in the Hillsborough County Health Care Plan (HCHCP). Assist contracted providers (physicians, hospitals, ancillary providers/facilities) with quality assurance aspects of their care to enrolled clients. Maintain uniform protocols followed by all contracted providers to ensure appropriate care to clients. Represents the County as its clinical liaison for the Drug Review Committee and the BOCC established Medical Subcommittee to advise on clinical and utilization issues. Serves as a resource for the HCHCP. Conducts special projects relating to the HCHCP. Manages communications and cooperation amongst the four networks and the care they provide to our clients.
Ideal Candidate
The ideal candidate will have five years' experience performing quality assurance, utilization review and clinical case management duties. Knowledge of Federal, State and community resources within Hillsborough County is preferred. The ideal candidate will be bilingual in English and Spanish and have at least three years experience working with Excel and Word. Experience working for a payor/insurance provider is desired.
Core Competencies
  • Customer Commitment - Proactively seeks to understand the needs of the customers and provide the highest standards of service.
  • Dedication to Professionalism and Integrity - Demonstrates and promotes fair, honest, professional, and ethical behaviors that establishes trust throughout the organization and with the public we serve.
  • Organizational Excellence - Takes ownership for excellence through one's personal effectiveness and dedication to the continuous improvement of our operations.
  • Success through Teamwork - Collaborates and builds partnerships through trust and the open exchange of diverse ideas and perspectives to achieve organizational goals.

Duties and Responsibilities
Note: The following duties are illustrative and not exhaustive. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. Depending on assigned area of responsibility, incumbents in the position may perform one or more of the activities described below.
  • Monitor procedural compliance of network providers.
  • Pursue quality of care inquiries.
  • Review medical records to determine accepted standards of care have been rendered and appropriately performed.
  • Plan agenda and prepare materials for HCAB Medical Subcommittee and Drug Review Committee meetings and promote attendance.
  • Attend Committee meetings and provide input and direction as applicable.
  • Function as a quality assurance liaison between the networks, providers and hospitals on client issues.
  • Participate and assist with the performance improvement programs of networks, providers and hospitals.
  • Provide patient outcome feedback as requested.
  • Identify training issues, prepares reports and related documentation.
  • Execute special projects involving the care of HCHCP clients.
  • Perform other special assignments, research and prepare reports, develop and implement programs.
  • Performs other related duties as required.

Job Specifications
  • Knowledge of nursing theory and practices.
  • Knowledge of general medical and surgical nursing techniques and procedures.
  • Knowledge of Quality Assurance policies and procedures.
  • Knowledge of the National Committee on Quality Assurance (NCQA) standards.
  • Knowledge of Utilization Review and Case Management policies and procedures.
  • Knowledge of Disability Determination criteria.
  • Ability to collect, organize and evaluate data and to develop logical conclusions.
  • Ability to follow oral and written instruction and ability to use a computer and related software.
  • Ability to prioritize work and work effectively with others.
  • Ability to communicate effectively both orally and in writing.

Physical Requirements
  • This position requires an employee to be able to sit for long periods of time and focus on complicated tasks.

Work Category
  • Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Minimum Qualifications Required
  • Possession of a valid State of Florida Registered Nurse license; AND
  • Five years of general medical or surgical nursing experience to include two years performing Quality Assurance, Utilization Review or Case Management duties; AND
  • Possession of a valid Florida Driver's License.

Emergency Management Responsibilities
In the event of an emergency or disaster, an employee may be required to respond promptly to duties and responsibilities as assigned by the employee's department, the County's Office of Emergency Management, or County Administration. Such assignments may be for before, during or after the emergency/disaster.
Additional Job Requirements
A department, depending on the nature of its mission and operations, may require that employees in all or certain positions in this job classification:
  1. Maintain the ability to pass the background checks required for the position. These background checks may include but are not limited to:
  • Criminal History Background Check using Florida Department of Law Enforcement (FDLE) Criminal Justice Information Services (CJIS)
  • Level 1 and Level 2 Background screening (Ch. 435 Florida Statutes)
  • Child Abuse, Abandonment and Neglect Record Check using the State Automated Child Welfare Information System (SACWIS)
  • Sex Offender and Sexual Predator record check using the list maintained by the Florida Department of Law Enforcement (FDLE)

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