Conducts daily reviews of medical records to assess the appropriateness, medical necessity, and utilization of hospital services, escalating cases as needed to the Physician Advisor or Utilization ...
Conducts daily reviews of medical records to assess the appropriateness, medical necessity, and utilization of hospital services, escalating cases as needed to the Physician Advisor or Utilization ...
RN Manager of Care Management
Naples, FL · On-site
Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness. * Directs and prioritizes workload ...
RN Manager of Care Management
Naples, FL · On-site
Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness. * Directs and prioritizes workload ...
Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness. * Directs and prioritizes workload ...
Oversees utilization review and discharge planning processes to ensure appropriateness of admission, continued stay, diagnostic services, and discharge readiness. * Directs and prioritizes workload ...
PRN Pharmacist
$58.78 - $69.15/hr
Works with patient medical information to conduct Drug Utilization Review (DUR) on all prescriptions and review clinical edits to ensure there is no adverse drug interaction. Maintains patient ...
PRN Pharmacist
$58.78 - $69.15/hr
Works with patient medical information to conduct Drug Utilization Review (DUR) on all prescriptions and review clinical edits to ensure there is no adverse drug interaction. Maintains patient ...
PRN Pharmacist
$58.78 - $69.15/hr
Works with patient medical information to conduct Drug Utilization Review (DUR) on all prescriptions and review clinical edits to ensure there is no adverse drug interaction. Maintains patient ...
PRN Pharmacist
$58.78 - $69.15/hr
Works with patient medical information to conduct Drug Utilization Review (DUR) on all prescriptions and review clinical edits to ensure there is no adverse drug interaction. Maintains patient ...
PRN Pharmacist
Fort Myers, FL · On-site
$51 - $61.25/hr
Works with patient medical information to conduct Drug Utilization Review (DUR) on all prescriptions and review clinical edits to ensure there is no adverse drug interaction. Maintains patient ...
PRN Pharmacist
Fort Myers, FL · On-site
$51 - $61.25/hr
Works with patient medical information to conduct Drug Utilization Review (DUR) on all prescriptions and review clinical edits to ensure there is no adverse drug interaction. Maintains patient ...
Bachelor's Degree in Nursing (BSN) preferred * 1-3 years of experience in an acute care or hospital setting required * 1-2 years of experience in care management or utilization review preferred ...
Bachelor's Degree in Nursing (BSN) preferred * 1-3 years of experience in an acute care or hospital setting required * 1-2 years of experience in care management or utilization review preferred ...
Bachelor's Degree in Nursing (BSN) preferred * 1-3 years of experience in an acute care or hospital setting required * 1-2 years of experience in care management or utilization review preferred ...
Bachelor's Degree in Nursing (BSN) preferred * 1-3 years of experience in an acute care or hospital setting required * 1-2 years of experience in care management or utilization review preferred ...
RN Case Manager
Naples, FL · On-site
... utilization review team to facilitate and meet organizational and department goals. · Recognizes situations that require referral to quality or risk management and makes a timely referral. · ...
RN Case Manager
Naples, FL · On-site
... utilization review team to facilitate and meet organizational and department goals. · Recognizes situations that require referral to quality or risk management and makes a timely referral. · ...
Revenue Cycle Director
Naples, FL · On-site
$60 - $73/hr
Oversee authorization and utilization review coordination to help ensure services are approved appropriately and claims issues are minimized before treatment begins. * Lead referral and intake ...
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Revenue Cycle Director
Naples, FL · On-site
$60 - $73/hr
Oversee authorization and utilization review coordination to help ensure services are approved appropriately and claims issues are minimized before treatment begins. * Lead referral and intake ...
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Home Care
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Home Care
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Nursing Home
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Nursing Home
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Nursing Home
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Nursing Home
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Inpatient
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Inpatient
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Inpatient
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Team Manager Inpatient
Naples, FL · On-site
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
RN Case Manager
Naples, FL · On-site
... utilization review team to facilitate and meet organizational and department goals. • Recognizes situations that require referral to quality or risk management and makes a timely referral.
RN Case Manager
Naples, FL · On-site
... utilization review team to facilitate and meet organizational and department goals. • Recognizes situations that require referral to quality or risk management and makes a timely referral.
Bachelor's Degree in Nursing (BSN) preferred * 1-3 years of experience in an acute care or hospital setting required * 1-2 years of experience in care management or utilization review preferred ...
Bachelor's Degree in Nursing (BSN) preferred * 1-3 years of experience in an acute care or hospital setting required * 1-2 years of experience in care management or utilization review preferred ...
Licensed Practical Nurse
Naples, FL · On-site
$40/hr
Participates in all required case conferences, utilization reviews, orientations, in-services and continuing education meetings. Qualifications: * Graduate of an Accredited School of Practical ...
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Licensed Practical Nurse
Naples, FL · On-site
$40/hr
Participates in all required case conferences, utilization reviews, orientations, in-services and continuing education meetings. Qualifications: * Graduate of an Accredited School of Practical ...
Utilization Review information
See Naples, FL salary details
$20.15 - $24.22
2% of jobs
$24.22 - $28.30
9% of jobs
$31.09 is the 25th percentile. Wages below this are outliers.
$28.30 - $32.38
21% of jobs
The median wage is $35.67 / hr.
$32.38 - $36.45
23% of jobs
$36.45 - $40.53
13% of jobs
$43.69 is the 75th percentile. Wages above this are outliers.
$40.53 - $44.60
10% of jobs
$44.60 - $48.68
8% of jobs
$48.68 - $52.75
5% of jobs
$52.75 - $56.83
5% of jobs
$56.83 - $60.90
2% of jobs
$60.90 - $64.98
2% of jobs
$20
$39
$64
How much do utilization review jobs pay per hour?
As of Aug 18, 2026, the average hourly pay for utilization review in Naples, FL is $39.82, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $45.72 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 Naples, FL?
The most popular types of Utilization Review jobs in Naples, FL are:
What are popular job titles related to Utilization Review jobs in Naples, FL?
For Utilization Review jobs in Naples, FL, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Naples, FL look for?
The top searched job categories for Utilization Review jobs in Naples, FL are:
What cities near Naples, FL are hiring for Utilization Review jobs?
Cities near Naples, FL with the most Utilization Review job openings:
Full-time
Medical, Dental, Vision, Retirement
Re-posted 18 days ago
Job description
Job Description
Join us as a Registered Nurse (RN) - Care Management LPN position at Physicians Regional Medical Center - CAMPUS
Unit: Care management
Shift:5x8 8-4:30 every other weekend and Holiday rotation
Other incentives include: Medical, Vision, Dental, 401k match & more available for eligible employees
Job Summary
The Care Manager LVN/ LPN supports effective utilization management and discharge planning by coordinating patient care activities under the direction of a Registered Nurse or physician. This role involves reviewing medical records for appropriateness and medical necessity, collaborating with interdisciplinary teams, and facilitating safe and timely transitions of care in compliance with federal, state, and accreditation standards.
Essential Functions
- Conducts daily reviews of medical records to assess the appropriateness, medical necessity, and utilization of hospital services, escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee.
- Identifies and documents avoidable hospital days and communicates findings effectively to the UM committee and interdisciplinary teams.
- Coordinates discharge planning activities, including arranging post-hospital placements and collaborating with patients, families, and physicians to ensure continuity of care.
- Maintains professional relationships with community agencies and resources to facilitate referrals and support patient transitions.
- Assists in facilitating interdisciplinary meetings, presenting relevant information, and supporting collaborative care planning.
- Ensures accurate and timely documentation of utilization review, discharge planning activities, and patient interactions in accordance with organizational policies.
- Directs others to comply with the federal mandate for first person reporting. This requirement cannot be delegated to another licensed staff member.
- Participates in the development, implementation, and evaluation of utilization management and discharge planning programs to enhance care delivery and compliance.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
Qualifications
- 1-2 years of clinical acute care nursing experience required
- Experience in utilization review, case management, or discharge planning preferred
Knowledge, Skills and Abilities
- Strong understanding of nursing practice, utilization management principles, discharge planning, and transitions of care.
- Knowledge of federal, state, and accreditation standards related to case management and patient care.
- Excellent communication and interpersonal skills to collaborate with interdisciplinary teams and community resources.
- Organizational and time management skills to prioritize tasks and meet deadlines in a dynamic environment.
- Proficiency in electronic medical records (EMR) systems and documentation processes.
- Ability to assess complex situations, identify solutions, and implement effective care plans.
Licenses and Certifications
- LPN - Licensed Practical Nurse - State Licensure Licensure in state of employment required or
- LVN - Licensed Vocational Nurse Licensure in state of employment required
- BLS - Basic Life Support preferred