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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 ...

NRG MGMT LLC

Collections Manager

Lake Worth, FL

Collaborate with Billing, Payment Posting, Credentialing, Utilization Review, and Contracting teams to resolve reimbursement barriers. Accounts Receivable Management * Review and monitor aging ...

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Showing results 21-40

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 22, 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 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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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 2% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $37,150 per year, or $17.9 per hour.

Infectious Diseases, Licensed Physician Reviewer - Infectious Disease (Remote PRN)

ChenMed Family of Companies

Palm Beach, FL

Full-time

Posted 9 days ago

Job description

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

    • Provides Delegated UM by covering the specified territories as assigned:
      • Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
    • Advises other physician reviewers.
    • Other duties as assigned and modified by manager.

 

KNOWLEDGE, SKILLS AND ABILITIES:

    • Excellent analytical and deductive reasoning skills
    • Good judgement and problem-solving skills
    • Professional and effective communication skills
    • Strong organizational skills
    • Written and verbal fluency in English
    • Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint

EDUCATION AND EXPERIENCE CRITERIA:

    • Graduate from accredited Medical School with a valid, unrestricted license is required
    • Completion of Infectious Disease Fellowship
    • Board Certification – Infectious Disease
    • Two (2) years’ experience in Hospital medicine preferred
    • At least one (1) year of utilization review experience preferred

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