Top 578 Utilization management nurse Jobs in Florida

Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $82,000 - $95,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Care Review Clinician (RN) Remote
Molina Healthcare —Mid Florida, FL
- $26.41 - $51.49 an hour
- 8 hour shift
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Behavioral Health Case Manager
The Hartford —Sunrise, FL
- $74,800 - $112,200 a year
- Full-time
- Hybrid work
- LMFT
- Microsoft Excel
- Licensed Clinical Social Worker
7d
Utilization Management Registered Nurse
Humana —Florida
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Case Manager, Registered Nurse
CVS Health —Florida
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Inpatient Care Management Nurse RN Florida - Remote
Optum —Orlando, FL
- $60,200 - $107,400 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health insurance
Quick Apply
1d
Registered Nurse (HUDVASH)
US Veterans Health Administration —West Palm Beach, FL
- $69,430 - $128,571 a year
- Online Application
- Hybrid work
- Background check
- Nursing
- Doctoral degree
- Paid holidays
- Dental insurance
2d
Registered Nurse-Intensive Care Unit
Health Care District of Palm Beach County —Belle Glade, FL
- Full-time
- Nursing
- RN License
- BLS Certification
Nurse Practitioner
Novus Physical Medicine and Pain Managment —Tallahassee, FL
- $200,000 - $230,000 a year
- Full-time
- Skilled nursing facility
- Mid-level
- Patient care
- Health insurance
- Dental insurance
Care Manager Registered Nurse ER
Physicians Regional Medical Center - Collier —Naples, FL
- Up to $20,000 a year
- Full-time
- Nursing
- RN License
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
Oncology RN Care Manager
Christian Care Ministry —Orlando, FL
- $74,500 - $101,500 a year
- Full-time
- 18 years or older
- Nursing
- Microsoft Excel
- Paid parental leave
- Health savings account
Psych PA/ Psychiatric Nurse Practitioner
Rockland Treatment Center —New Port Richey, FL
- $120,000 - $155,000 a year
- Full-time
- Background check
- CPR Certification
- Psychiatry
Quick Apply
11d
Care Manager Registered Nurse Home Health
AdventHealth Home Health and Hospice —Altamonte Springs, FL
- $31.85 - $52.76 an hour
- Full-time
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
Staff Nurse, RN
ViaMar Health —West Palm Beach, FL
- $32 - $35 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
Quick Apply
Pediatric Dialysis Nurse Manager
Nemours —Orlando, FL
- Full-time
- Acute care
- Nursing
- RN License
RN Nurse Reviewer
CSTS Customer Service and Technology Solutions LLC —Tampa, FL
- $74,000 a year
- Weekends as needed
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Registered Nurse Team Manager Nursing Home
VITAS Healthcare —Deerfield Beach, FL
- Full-time
- Nursing
- RN License
- Nursing home
- Disability insurance
- Health insurance
Quick Apply
Advanced Practice Nurse - Internal Medicine post acute settings
Jacksonville Hospitalists —Orange Park, FL
- $110,000 - $130,000 a year
- Part-time
- Background check
- Nursing
- Skilled nursing facility
- Health insurance
- Dental insurance
Quick Apply
1d
Nursing Care Coordinator (LPN / RN)
MedElite Group, LLC. —Hollywood, FL
- $30 - $35 an hour
- Full-time
- Google Workspace
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
RN Clinical Manager
Patients First Home Care LLC —Clearwater, FL
- $80,000 - $90,000 a year
- Full-time
- Background check
- CPR Certification
- Current TB test
- Continuing education credits
- Paid holidays
Quick Apply

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Utilization Review Nurse

Cobalt Benefits Group LLC -
Orlando, FL

Quick Apply

Job Details

Full-time
$82,000 - $95,000 a year

Benefits

Health savings account
AD&D insurance
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Vision insurance

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
RN License
Patient care
Desktop applications
Resource utilization in healthcare

Full Job Description

Description:

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse (UR Nurse), you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.

The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and levels of care in accordance with established criteria, payer guidelines, and organizational policies. This role involves evaluating healthcare services and facilities under the provisions of applicable health benefit plans to ensure quality and cost-effective patient care.

The UR Nurse collaborates closely with intake staff, physicians, specialists, case managers, and other members of the care team to facilitate timely and effective care authorizations, transitions, and utilization determinations. Strong communication, clinical judgment, and attention to detail are essential to ensure services meet both clinical standards and benefit requirements.

Responsibilities

Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria.
Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria.
Request and evaluate clinical information needed to review requested services.
Discuss cases and determinations with healthcare professionals and physician reviewers.
Identify cases requiring intervention and collaborate with Case Managers as needed.
Maintain appropriate and accurate documentation, ensuring compliance with audit standards.
Participate in team meetings, educational sessions, and related activities.
Review medical claims and pre-determinations for medical necessity and appropriateness.
Identify opportunities for process improvement and enhance communication among departments.
Consult with Physician Reviewers for complex or challenging cases.

Requirements:

Current, unrestricted RN license (State license required).
Minimum 3 years of clinical nursing experience.
Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Strong analytical, critical thinking, and problem-solving skills.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and familiarity with utilization management systems.
Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.
Strong organizational and time management skills, with the ability to handle multiple priorities independently.

Preferred Qualifications

Experience with Milliman or Aetna criteria.
Background in healthcare administration, medical necessity determination, or benefits management.
Experience in data interpretation and medical trend analysis.

Work Environment & Physical Demands

Prolonged periods of sitting may be required.
Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.
Employees should ensure an ergonomically appropriate desk and chair setup.
Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)

Benefits

After successfully completing a waiting period, eligible Full-time employees have access to our comprehensive benefits package, including:

Fantastic medical, dental, and vision insurance*
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company provided Basic Life and AD&D
Company paid Short-Term and Long-Term Disability**
Flexible Spending Accounts*
401(k) Retirement Plan with up to a 6% employer-match** WOW! (100% fully vested after 3 years)
10+ paid holidays
Fully Paid half day Summer Fridays
Generous paid vacation and sick time
Annual Paid Volunteer Day
Annual Tuition Reimbursement
Annual Health and Wellness Reimbursement
Lots of fun company events

*60 day waiting period**90 day waiting period

Who We Are

As a trusted third-party administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four lines of business: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue,and Great Bay Administrators. With over 30 years of experience and a dedicated team of more than 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit https://www.cobaltbenefitsgroup.com/careers/.

Cobalt Benefits Group is an Equal Employment Opportunity employer.

Cobalt Benefits Group participates in E-Verify to confirm the employment eligibility of all new hires.

Quick Apply

Refine Your Search

utilization management nurse jobs in florida

Utilization Review Nurse

Care Review Clinician (RN) Remote

Behavioral Health Case Manager

Utilization Management Registered Nurse

Case Manager, Registered Nurse

Inpatient Care Management Nurse RN Florida - Remote

Registered Nurse (HUDVASH)

Registered Nurse-Intensive Care Unit

Nurse Practitioner

Care Manager Registered Nurse ER

Oncology RN Care Manager

Psych PA/ Psychiatric Nurse Practitioner

Care Manager Registered Nurse Home Health

Staff Nurse, RN

Pediatric Dialysis Nurse Manager

RN Nurse Reviewer

Registered Nurse Team Manager Nursing Home

Advanced Practice Nurse - Internal Medicine post acute settings

Nursing Care Coordinator (LPN / RN)

RN Clinical Manager

I want to receive the latest job alert for utilization management nurse in florida

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