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Utilization Review Jobs in New Port Richey, FL (NOW HIRING)

Enlyte

Utilization Reviewer 2

Tampa, FL

$59K - $76K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

Genex Services

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

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All JobsUtilization Review JobsUtilization Review Jobs in New Port Richey, FL

Utilization Review information

See New Port Richey, FL salary details

$19

$37

$61

How much do utilization review jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review in New Port Richey, FL is $37.66, according to ZipRecruiter salary data. Most workers in this role earn between $29.76 and $43.27 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, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

What are the most commonly searched types of Utilization Review jobs in New Port Richey, FL?

The most popular types of Utilization Review jobs in New Port Richey, FL are:

What are popular job titles related to Utilization Review jobs in New Port Richey, FL?

For Utilization Review jobs in New Port Richey, FL, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in New Port Richey, FL look for?

The top searched job categories for Utilization Review jobs in New Port Richey, FL are:

What cities near New Port Richey, FL are hiring for Utilization Review jobs?

Cities near New Port Richey, FL with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in New Port Richey, FL as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $78,333 per year, or $37.7 per hour.

Utilization Review Nurse

Healthcare Support Staffing

Tampa, FL

$29 - $30/hr

Full-time

Re-posted 23 days ago

Job description

Company Description

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!

Job Description

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.


Qualifications

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]


Additional Information

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


Healthcare Support logo

About Healthcare Support

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.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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