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

Dane Street

Chiropractor

Tampa, FL · On-site

$69K - $85K/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

Elevance Health

Med Mgmt Nurse

Tampa, FL

Utilization Review experience is preferred. * Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is ...

Elevance Health

Med Mgmt Nurse

Tampa, FL · On-site

Utilization Review experience is preferred. * Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is ...

New

Acadia Healthcare

Registered Nurse

Wesley Chapel, FL

$36 - $44/hr

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for ...

Hire Talent

Review Assistant - Mailroom

Tampa, FL · On-site

$15 - $19/hr

... effective review process Attending training and scheduled meetings, maintaining up-to-date ... utilization of essential software tools Preferred Qualifications Familiarity with government ...

Acadia Healthcare

Registered Nurse

Wesley Chapel, FL · On-site

$36 - $44/hr

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for ...

Aspire Home Care

Home Health Supervisor

Clearwater, FL · On-site

Participates in agency's audit and Utilization Review Committee as directed. 14. Performs other duties as assigned. QUALIFICATIONS: 1. Education: Graduation for an accredited School of Nursing. Must ...

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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, 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 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, 79% Full Time, 15% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $78,333 per year, or $37.7 per hour.

LPN Charge Nurse/MDS Coordinator

TJM PROPERTY MANAGEMENT INC

Clearwater, FL • On-site

$31.50 - $40.25/hr

Other

Posted 18 days ago

Job description

We are seeking a highly skilled and detail-oriented MDS Coordinator (Must have active FL RN or LPN Nursing License) to join our healthcare team. The ideal candidate will possess comprehensive knowledge of the Minimum Data Set (MDS)/PDPM process, clinical documentation, and regulatory compliance standards. As an essential member of our interdisciplinary team, the MDS Coordinator will oversee the accurate collection, review, and submission of resident data to ensure optimal reimbursement, quality reporting, and compliance with federal and state regulations. This role offers an opportunity to contribute significantly to patient care quality and operational efficiency within a dynamic healthcare environment.
Responsibilities
  • Coordinate the comprehensive assessment and documentation of resident conditions in accordance with MDS guidelines, ensuring accuracy and completeness.
  • Collaborate with nursing staff, physicians, case managers, and other healthcare professionals to gather pertinent clinical information for MDS completion.
  • Review medical records, clinical documentation, and coding details-including ICD-10 codes-to support precise data entry and compliance with SNF Medicare and other payer requirements.
  • Ensure timely submission of MDS assessments in alignment with regulatory deadlines while maintaining adherence to state-specific regulations.
  • Utilize EMR (Electronic Medical Record) systems such as Point Click Care or similar to document assessments within the electronic health record (EHR)
  • Conduct ongoing education for staff on documentation improvement strategies, utilization management, and coding updates related to ICD coding systems.
  • Monitor quality metrics related to clinical documentation improvement (CDI), discharge planning, hospice care, and case management processes to optimize patient care outcomes.
  • Maintain strict compliance with HIPAA regulations while managing sensitive medical records and ensuring confidentiality throughout all documentation processes.

Qualifications
  • Proven experience in managed care settings or hospital environments with a strong understanding of inpatient and outpatient clinical workflows.
  • Extensive knowledge of Point Click Care, Simple LTC or similar EMR Systems
  • 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 documentation review.
  • Strong understanding of SNF Medicare regulations, discharge planning procedures, and hospice care protocols.
  • Excellent organizational skills coupled with the ability to interpret complex medical terminology and physiology knowledge for accurate data collection.

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