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Utilization Reviewer Jobs in Jupiter, FL (NOW HIRING)

ScionHealth

Case Manager, PRN Day

Riviera Beach, FL · On-site

Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise ...

Sanitas

Certified Medical Assistant (68015)

Boynton Beach, FL · On-site

$16 - $20.50/hr

Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...

MyFlorida

OPS SENIOR DENTIST - 64858665

Lake Worth, FL · On-site

$91/hr

Skilled in the techniques of oral communication and methods of utilization review; knowledge of complex medical terminology; ability to ambulate, climb stairs, bend and lift up to 20 pounds on a ...

MyFlorida

OPS SENIOR DENTIST - 64858665

Tequesta, FL · On-site

$91/hr

Skilled in the techniques of oral communication and methods of utilization review; knowledge of complex medical terminology; ability to ambulate, climb stairs, bend and lift up to 20 pounds on a ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Jupiter, FL

Utilization Reviewer information

See Jupiter, FL salary details

$30.3K

$37.1K

$43K

How much do utilization reviewer jobs pay per year?

As of Aug 8, 2026, the average yearly pay for utilization reviewer in Jupiter, FL is $37,150.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,200.00 and $41,100.00 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 job categories do people searching Utilization Reviewer jobs in Jupiter, FL look for? The top searched job categories for Utilization Reviewer jobs in Jupiter, FL are:
What cities near Jupiter, FL are hiring for Utilization Reviewer jobs? Cities near Jupiter, FL with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Jupiter, FL as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $37,150 per year, or $17.9 per hour.

Utilization Review Specialist.

ELEMENT MEDICAL BILLING, LLC

Port Saint Lucie, FL • On-site

Full-time

Re-posted 12 days ago

Job description

Job Summary

We are seeking a highly motivated and detail-oriented Utilization Reviewer to join our dynamic healthcare team. In this pivotal role, you will evaluate medical records, clinical documentation, and patient care plans to ensure appropriate utilization of healthcare services. Your expertise will support clinical decision-making, promote compliance with regulatory standards, and optimize patient outcomes. The ideal candidate will possess a strong foundation in medical terminology, coding, and utilization management processes, with a passion for improving healthcare efficiency and quality.

Duties

Review medical documentation, including clinical notes, discharge summaries, and treatment plans to assess medical necessity and appropriateness of services.

Utilize advanced electronic health record (EHR) systems such as Epic, Cerner, Athenahealth, or eClinicalWorks to access and analyze patient information efficiently.

Apply knowledge of CPT coding, ICD-9/10 coding systems, DRGs (Diagnosis-Related Groups), and MDS (Minimum Data Set) to accurately classify diagnoses and procedures.

Conduct utilization reviews for inpatient and outpatient services across various settings including acute care hospitals, nursing homes, hospice care, emergency departments, PICUs (Pediatric Intensive Care Units), and Level I/II trauma centers.

Collaborate with multidisciplinary teams to facilitate discharge planning, case management, and clinical documentation improvement initiatives aligned with NCQA standards.

Ensure compliance with HIPAA regulations while handling sensitive patient information and medical records.

Participate in ongoing education related to managed care policies, Medicare/Medicaid guidelines, and evolving healthcare regulations to maintain current knowledge.

Experience

Proven experience in utilization review or utilization management within hospital or managed care environments.

Strong background in clinical settings such as ICU, emergency medicine, primary care, pediatrics, or nursing homes.

Familiarity with EMR/EHR systems like Epic, Cerner, Athenahealth or eClinicalWorks is essential for efficient workflow.

In-depth understanding of medical coding including CPT, ICD-9/10 codes, DRGs, and case management documentation standards.

Critical care experience or ICU background is highly desirable for assessing complex cases accurately.

Knowledge of Medicare regulations and NCQA standards to ensure compliance during reviews.

Excellent analytical skills combined with a thorough understanding of anatomy physiology and medical terminology to interpret complex clinical data effectively. Join us in making a meaningful impact on patient care by ensuring the appropriate use of healthcare resources! We are committed to fostering an inclusive environment that supports your professional growth while promoting work-life balance through comprehensive benefits designed to support your overall well-being.

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