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Utilization Review Jobs in Spring Hill, FL (NOW HIRING)

LIBERTY DENTAL

Senior Staff Dentist

Tampa, FL · On-site +1

$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

Molina Healthcare

Care Review Clinician, ABA

Tampa, FL · On-site

$26.41 - $51.49/hr

  • Medical

Job Summary Provides support for member clinical review processes specific to applied behavioral ... Works collaboratively with the utilization and care management departments to provide ABA and ...

Molina Healthcare

Care Review Clinician, ABA

Tampa, FL

$26.41 - $51.49/hr

  • Medical

Works collaboratively with the utilization and care management departments to provide ABA and ... Approves prior authorization requests for BHT treatment by reviewing BHT assessments and treatment ...

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Conducts initial medical necessity review of exception preauthorization requests for services ... Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health ...

NHR

Physician Internal Medicine - Competitive Salary

Tampa, FL · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Offers clinical support case management, and utilization review/management. * Consults with facility-level staff regarding delegated utilization management and disease management operations under ...

VITAS Healthcare

Team Manager Nursing Home

Lutz, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

VITAS Healthcare

Team Manager Home Care

Lutz, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Molina Healthcare

Care Review Clinician (RN)

Tampa, FL

$26.41 - $51.49/hr

Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...

Facility Management Company

Be Seen First

Regional Operations Manager

Tampa, FL · On-site

$119K - $125K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Achieve greater efficiencies through effective resource utilization, review of work and re-work volume, and review and development of corrective solutions leveraging internal solutions as applicable.

Sanitas Medical Center

Medical Director

Tampa, FL

Provides leadership for several activities related to the delivery of medical care and clinical services such as cost management, utilization review and quality assurance. * Collaborates in the ...

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All JobsUtilization Review JobsUtilization Review Jobs in Spring Hill, FL

Utilization Review information

See Spring Hill, FL salary details

$18

$35

$58

How much do utilization review jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review in Spring Hill, FL is $35.87, according to ZipRecruiter salary data. Most workers in this role earn between $28.37 and $41.20 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 Spring Hill, FL?

The most popular types of Utilization Review jobs in Spring Hill, FL are:

What are popular job titles related to Utilization Review jobs in Spring Hill, FL?

For Utilization Review jobs in Spring Hill, FL, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Spring Hill, FL look for?

The top searched job categories for Utilization Review jobs in Spring Hill, FL are:

What cities near Spring Hill, FL are hiring for Utilization Review jobs?

Cities near Spring Hill, FL with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Spring Hill, FL as of August 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 100% In-person job distribution, with an average salary of $74,613 per year, or $35.9 per hour.

Senior Staff Dentist

LIBERTY DENTAL

Tampa, FL • On-site, Remote

$175K - $185K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 27 days ago

Job description

About the Role
LIBERTY Dental Plan is seeking an experienced and clinically driven Senior Staff Dentist to join our Clinical Affairs team. In this leadership role, you will help ensure the delivery of high-quality, cost-effective dental care by providing clinical oversight of utilization management and claims review processes.
This position offers the opportunity to influence care quality and provider engagement across Commercial, Medicare Advantage, and Medicaid programs while contributing to meaningful oral health initiatives. You'll collaborate with cross-functional teams and serve as a mentor and clinical resource to support consistent, evidence-based decision-making across the organization.
** This role requires an Active, unrestricted Florida dental license in good standing **
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
  • Interpret dental records, radiographs, and benefit structures to assess medical necessity and coverage decisions
  • Identify inappropriate utilization patterns and recommend improvements to align with best practices
  • Conduct retrospective utilization reviews and support provider behavior change initiatives
  • Complete appeal, grievance, and secondary review determinations

Quality, Compliance & Improvement
  • Participate in quality management and performance improvement programs, including audits and provider performance initiatives
  • Conduct chart reviews to identify trends in care delivery and utilization
  • Support grievance resolution and contribute to regulatory reporting and compliance activities
  • Provide clinical insight during committee reviews and quality improvement efforts

Provider Engagement & Peer Collaboration
  • Lead peer-to-peer consultations with providers to discuss clinical decisions, utilization trends, and quality concerns
  • Support provider education around compliance, documentation, and care standards
  • Partner with specialists and subject matter experts on complex clinical cases

Leadership & Organizational Impact
  • Mentor staff dentists and support clinical calibration efforts to ensure consistency across reviews
  • Provide guidance to utilization management and claims teams
  • Collaborate with Analytics, Claims, UM, and outreach teams to improve operational outcomes
  • Participate in state oral health initiatives and organizational programs
A Day in the Life
In this role, your day is a blend of clinical review, collaboration, and quality improvement work:
  • ~75% reviewing dental claims and utilization requests to ensure accuracy, compliance, and appropriate care decisions
  • ~10% supporting quality initiatives, including investigating clinical trends and addressing care concerns
  • ~5% handling expedited reviews with quick turnaround times to support members and providers
  • ~5% participating in care management or interdisciplinary coordination efforts
  • ~5% engaging in team collaboration, provider discussions, and other organizational priorities

You'll regularly partner with teams across Analytics, Utilization Management, Claims, and Provider Outreach, while also connecting directly with network dentists through peer-to-peer consultations.
What You'll Bring
Required Qualifications
  • DDS or DMD from an accredited institution
  • Active, unrestricted Florida dental license in good standing (required)
  • Ability to obtain additional state licenses as needed (company-supported)
  • Minimum 6 years of experience as a practicing dentist
  • At least 2 years of experience in utilization management, claims review, or quality improvement initiatives

Preferred Qualifications
  • Experience in the dental benefits or managed care industry
  • Experience mentoring or training peers
  • Multi-state licensure
  • Familiarity with Medicaid programs

Key Skills & Expertise
  • Strong clinical judgment and knowledge of dental procedures, coding, and adjudication guidelines
  • Ability to interpret radiographs and dental records
  • Knowledge of managed care systems, reimbursement models, and regulatory requirements
  • Experience identifying fraud, waste, and abuse trends
  • Strong collaboration, communication, and provider engagement skills
  • Proficiency with Microsoft Office and the ability to learn new systems quickly
Work Environment & Impact
  • Remote role with collaboration across national teams
  • High-impact role shaping clinical standards and improving member outcomes
Compensation
  • Salary Range: $175,000 - $185,000 annually
    (Final compensation will depend on experience, qualifications, and licensure.)
Why Join LIBERTY Dental Plan?
At LIBERTY, you'll be part of a mission-driven organization dedicated to improving oral health outcomes through quality, innovation, and collaboration. This role allows you to leverage your clinical expertise beyond traditional practice-impacting care delivery at scale while working alongside a passionate and supportive team.
Ready to Make an Impact?
If you are a clinically strong, collaborative dentist with an active Florida license and a passion for improving the quality of care, we encourage you to apply today.
Location
Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.
What Liberty Offers
Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.
Our first-class benefits package supports employees and their dependents with:
  • Competitive pay structure and savings options to help you reach your financial goals.
  • Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
  • Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
  • 100% employer-paid dental coverage for employees and eligible dependents.
  • Vision insurance with low-cost premiums for employee-only coverage and dependents.
  • Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
  • Flexible Spending Accounts for healthcare and dependent care expenses.
  • Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
  • Long-term disability coverage.
  • Expansive wellness programs, including company-wide wellness challenges, and gym discounts.
  • Employee Assistance Program (EAP) to support mental health and well-being.
  • Generous vacation and sick leave policies, with the ability to roll over unused time.
  • 10 paid company holidays.
  • Tuition reimbursement for eligible educational expenses.
  • Remote or hybrid work options available for various positions.

Compensation
In the spirit of pay transparency, the base salary range for this position is $175,000 - $185,000 annually, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.
Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.
Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.
Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.
We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.
Sponsorship and Relocation Specifications
Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.

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