ZipRecruiter

Log In

1

Utilization Reviewer Jobs in Florida (NOW HIRING)

SBT

Be Seen First

Utilization Review (UR) Specialist

Boca Raton, FL · On-site

$60K - $70K/yr

Utilization Review (UR) Specialist Location: Boca Raton, FL Job Type: Full-time, In-Person Pay: $60,000 - $70,000 per year, based on experience We are seeking a full-time Utilization Review (UR ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Oakland Park, FL · On-site

The Director of Utilization Management is also responsible for ensuring that the utilization review process meets the integrity standards set by FLBHC and UHS. The Director: interfaces with clinical ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...

UHS

PRN UTILIZATION REVIEW COORDINATOR

Jacksonville, FL · On-site

PRN Utilization Review Coordinator, including weekends $26-$37 This position is responsible for monitoring the treatment activities offered to the patient, interfacing with the treatment team/managed ...

previous pagenext page

Showing results 21-40

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 8, 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 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 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 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.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Florida? For Utilization Reviewer jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Florida look for? The top searched job categories for Utilization Reviewer jobs in Florida are:
What cities in Florida are hiring for Utilization Reviewer jobs? Cities in Florida with the most Utilization Reviewer job openings:
What are popular job titles related to Utilization Reviewer jobs in FL? For Utilization Reviewer jobs in FL, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Florida as of July 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 1% Temporary, and 2% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $28,391 per year, or $13.6 per hour.

Utilization Review Specialist

New Horizons of the Treasure Coast

Fort Pierce, FL • On-site

Full-time

Posted 4 days ago

Job description

Description:

New Horizons is the largest mental health and addiction recovery provider on the Treasure Coast (and beyond), serving 15,000 children and adults annually through inpatient crisis services, 24-hour help line and mobile response team, and outpatient programs conveniently located across Indian River, Martin, Okeechobee and St. Lucie counties. In addition, New Horizons assists 22,000 students in area schools, and we work closely with the courts, law enforcement, jails, and hospitals to help improve the health of individuals and the quality of life in our community.


New Horizons is seeking an Utilization Review Specialist, who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-certification timely via telephone or provider portal, review patients medical record via EMR to ensure criteria for the appropriate level of care is met, and provide clinical to insurance company to obtain authorization. This position is considered a Hybrid role.



As a Utilization Review Specialist, your responsibilities will include:

  • Follow each account during the IP stay and on discharge for authorization - document status in the electronic system,
  • Escalate any potential disputes or denial of accounts to Director of Revenue or designee
  • Trends disputed claims by payor
  • Obtain & follow authorization for Case Management Services
  • Adhere to federal, state, payer, and local regulations and accreditation requirements impacting case management scope of services
  • Adhere to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and agency policies


Requirements:

REQUIRED:

  • High School diploma or equivalent required.
  • organizational skills,
  • verbal and written communication skills,
  • problem solving skills,
  • computer literacy.

Preferred:

  • Associate or Bachelor’s degree preferred.
  • Paramedic, EMT or Nursing Assistant certification preferred.
  • Acute hospital experience preferred
  • Data Analytic skills preferred.