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Utilization Reviewer Jobs in Florida (NOW HIRING)

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

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

$59K - $76K/yr

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

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 ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Florida

Utilization Reviewer information

See Florida salary details

$23.2K

$28.4K

$32.9K

How much do utilization reviewer jobs pay per year?

As of Aug 31, 2026, the average yearly pay for utilization reviewer in Florida is $28,391.00, according to ZipRecruiter salary data. Most workers in this role earn between $25,400.00 and $31,400.00 per year, depending on experience, location, and employer.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
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The top searched job categories for Utilization Reviewer jobs in Florida are:

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Cities in Florida with the most Utilization Reviewer job openings:

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Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Florida as of August 2026, with employment types broken down into 71% Full Time, and 29% Part Time. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $28,391 per year, or $13.6 per hour.

UTILIZATION REVIEWER

Larkin Community Hospital

Miami, FL • On-site

Other

Posted 24 days ago

Job description

(1) Full-Time Utilization Reviewer:
Monday through Friday 8:30 a.m. - 5:00 p.m.
Qualifications:
  • Clinical Background with 2 years of UR experience
  • RN (or) Master level Clinician
  • CPI Certification required
  • Experience in Psychiatric facility preferred
  • Bilingual (English/Spanish) preferred
  • 3-5 years' experience of Mental Health and Substance Abuse in an Inpatient setting.

EQUAL OPPORTUNITY EMPLOYER
Larkin Behavioral Health Services is an Equal Opportunity Employer committed to nondiscrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender status, marital status, age, disability, or covered veteran's status consistent with applicable federal and state laws.
Larkin Community Hospital logo

About Larkin Community Hospital

Sourced by ZipRecruiter

At Larkin, we have been serving the health care needs of South Miami, Hialeah, and the surrounding communities for more than 40 years. We take pride in the continuing tradition of caring. We remain dedicated to providing excellent medical care with the personal touch and convenience that only a community hospital offers.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

South Miami, FL, US

Year founded

1969

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