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

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 ...

Tampa General Hospital

Pool Case Manager RN

Tampa, FL · On-site

Ability to accurately document care plans, utilization review findings, avoidable days, anticipated discharge dates, and required data across multiple electronic systems. * Develops, documents, and ...

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

TJM Properties

LPN Charge Nurse/MDS Coordinator

Belleair, FL · On-site

$31 - $39.50/hr

Familiarity with ICD-10 coding standards, DRG assignment, and utilization review processes. * Background in medical office administration or health information management with a focus on medical ...

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 New Port Richey, FL

Utilization Review information

See New Port Richey, FL salary details

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$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:

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

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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.

Physician Advisor - UM MSQ

BayCare Health System

Tampa, FL • On-site

Other

Re-posted 9 days ago

BayCare Health System rating

7.5

Company rating: 7.5 out of 10

Based on 401 frontline employees who took The Breakroom Quiz

236th of 887 rated healthcare providers

Job description

Why BayCare?

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Summary:

  • Charged with meeting the organization's goals and objectives for assuring the effective, efficient utilization of health care services. Is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership.

  • Develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.

  • Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided.

  • This includes working with hospital leadership in developing care management protocols with physicians and others to optimize length of hospital stay and efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.

Minimum Qualifications:

Education:

  • Required - Doctorate - Medical Doctor; Or - Doctorate - Osteopathic Medicine

Credentials:

  • Required - Medical Board - License

Experience:

  • 5 years Clinical Related

  • 1 year Education

Preferred qualifications:

  • Member of the American College of Physician Advisors (ACPA), Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP), Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP).

Facility: BayCare Health System, Physician Advisor Services-HSS

Location: St Josephs Main and Childrens

Status: Part Time, Exempt: Yes

Shift Hours: 8:00 AM - 4:00 PM

Weekend Work: None

On Call: No

How often will this team member be working remotely? Hybrid

Equal Opportunity Employer Veterans/Disabled

Position Physician Advisor - UM MSQ

Location Tampa:St Josephs | Physician | Part Time

Req ID 161706

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