Tampa, FL · On-site
Medical
Dental
Vision
PTO
Established in 1986, our high-tech and high-touch offerings include innovative medical management systems, face to face community care coordination services, utilization review, clinical data ...
Tampa, FL · On-site
Medical
Dental
Vision
PTO
Established in 1986, our high-tech and high-touch offerings include innovative medical management systems, face to face community care coordination services, utilization review, clinical data ...
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
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
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
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
Tampa, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
Tampa, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
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
Quick apply
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
Tampa, FL · On-site
$73K - $88K/yr
Medical
Life
Retirement
PTO
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, FL · On-site
$73K - $88K/yr
Medical
Life
Retirement
PTO
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 ...
Medical
Dental
Vision
Life
Retirement
PTO
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 ...
Medical
Dental
Vision
Life
Retirement
PTO
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 ...
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Wound Care Utilization Management RN Wound Care Utilization Management RN Virtual : This role ... Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ...
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Wound Care Utilization Management RN Wound Care Utilization Management RN Virtual : This role ... Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
$33K - $45K/yr
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 ...
$33K - $45K/yr
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Wesley Chapel, FL · On-site
$36 - $44/hr
Medical
Dental
Vision
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 ...
Clearwater, FL · On-site
PTO
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 ...
Quick apply
Clearwater, FL · On-site
PTO
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 ...
Tampa, FL · On-site
$52K - $65K/yr
Provides utilization reviews to insurance companies, providing appropriate clinical information to obtain initial authorization and continuing stay authorization, as necessary. * Is appropriately ...
Tampa, FL · On-site
$52K - $65K/yr
Provides utilization reviews to insurance companies, providing appropriate clinical information to obtain initial authorization and continuing stay authorization, as necessary. * Is appropriately ...
Tampa, FL · Remote
$175K - $185K/yr
Medical
Dental
Vision
Life
Retirement
PTO
What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations
Tampa, FL · Remote
$175K - $185K/yr
Medical
Dental
Vision
Life
Retirement
PTO
What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations
$18.15 - $21.82
2% of jobs
$21.82 - $25.49
9% of jobs
$28 is the 25th percentile. Wages below this are outliers.
$25.49 - $29.16
21% of jobs
The median wage is $32.14 / hr.
$29.16 - $32.83
23% of jobs
$32.83 - $36.51
13% of jobs
$39.36 is the 75th percentile. Wages above this are outliers.
$36.51 - $40.18
10% of jobs
$40.18 - $43.85
8% of jobs
$43.85 - $47.52
5% of jobs
$47.52 - $51.19
5% of jobs
$51.19 - $54.86
2% of jobs
$54.86 - $58.53
2% of jobs
$18
$35
$58
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.
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.
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.
The most popular types of Utilization Review jobs in Spring Hill, FL are:
For Utilization Review jobs in Spring Hill, FL, the most frequently searched job titles are:
The top searched job categories for Utilization Review jobs in Spring Hill, FL are:
Cities near Spring Hill, FL with the most Utilization Review job openings:
Tampa, FL • On-site
Full-time
Medical, Dental, Vision, PTO
Re-posted 6 hours ago
Company:
Established in 1986, our high-tech and high-touch offerings include innovative medical management systems, face to face community care coordination services, utilization review, clinical data integration and business intelligence analytical reporting – all focusing on increased quality outcomes and optimization of provider and payer networks. Our company serves a variety of entities across the US, including federal, state and commercial clients.
Summary:
Organization is seeking a psychiatrist to function as Clinical Director of Behavioral Analysis. This is not a clinical role, functions as Senior Physician Executive responsible for clinical activities of the company. Provides clinical leadership to the strategic, operational, and quality issues of any of companies Utilization Management contract. Responsible for contract’s clinical policies and decisions. Seeks strategic opportunities and relationships in fulfillment of company solutions’ mission. Ensures that all functions of the medical department are carried out in a manner that meets the needs of organization. Maintains second level review panel at level and specificity to support contract needs. Serves a key leadership role in directing and communicating companies mission and vision to both internal and external audiences.
Benefits:
Compensation: 225K - 250K
Bonus: Annual merit based review
Benefits: 5K for CME, health (vision/dental), malpractice, PTO, PLI and vacation
Hours: 8 hour days, flexible, works from office 3 days a week and 2 days from home
Pediatric experience is a necessity for consideration
Requirements & Qualifications:
Must be a graduate of an approved School of Medicine with an unrestricted license to practice medicine in the State of Florida. Board certified in a specialty recognized by American Board of Medical Specialties, in Psychiatry.
Minimum five years clinical experience post residency. Three years utilization experience. Experience in a Quality Improvement environment preferred. Training in public health and/or epidemiology preferred. Medicaid experience. Experience in a HIPAA compliant environment. Must have never been sanctioned in conjunction with activities of CMS, and never had a disciplinary action by a provider or any professional licensing board. Main practice with Adolescents and young adults under age 21.
Sourced by ZipRecruiter
Masc Medical is a prominent healthcare staffing firm based in Fort Lauderdale, Florida, US. As a recognized name in the healthcare industry, the company effectively connects healthcare providers and organizations across the country. Dedicated to offering a comprehensive set of recruitment services, Masc Medical helps healthcare organizations fill permanent vacancies as efficiently and effectively as possible. The company was established on a mission to pair medical offices with qualified healthcare professionals, striving to become an industry leader.
Recruiting and staffing services
1 - 10 Employees
Fort Lauderdale, FL, US
2010
