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Executive Nurse Practitioner Utilization Review Jobs

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Sentara Health Plans

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

Minimum 5 years of clinical nursing experience * Experience in Care Coordination, Utilization Review, and Discharge Planning * MLTC experience required * Computer proficiency required * PRI and ...

Pride Health

Utilization Review Nurse

Queens, NY · On-site

$2.8K/wk

Job title: RN - Utilization Review Job location : East Elmhurst, NY 11370-1381 Shift : 8:30 AM-5:00 PM Length : 8 weeks, Possible extension Local Hourly pay: $60 - $63/hr Travel Weekly Pay upto ...

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Executive Nurse Practitioner Utilization Review information

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$71K

$134.4K

$210.5K

How much do executive nurse practitioner utilization review jobs pay per year?

As of Sep 3, 2026, the average yearly pay for executive nurse practitioner utilization review in the United States is $134,369.00, according to ZipRecruiter salary data. Most workers in this role earn between $111,000.00 and $152,500.00 per year, depending on experience, location, and employer.

What is an Executive Nurse Practitioner Utilization Review?

Executive Nurse Practitioner Utilization Review professionals are advanced practice nurses who oversee and manage the evaluation of medical services to ensure they are necessary, efficient, and cost-effective. They combine clinical expertise with leadership skills to review patient care plans, monitor compliance with healthcare policies, and improve the quality of care. These professionals often work with insurance companies, hospitals, or healthcare organizations to assess the appropriateness of treatments and coordinate care delivery. Their role is essential in balancing patient needs with organizational resources while maintaining regulatory standards.

What are the key skills and qualifications needed to thrive as an Executive Nurse Practitioner Utilization Review?

To excel as an Executive Nurse Practitioner Utilization Review, you need advanced clinical expertise, a graduate nursing degree (DNP or MSN), board certification as a nurse practitioner, and in-depth knowledge of healthcare regulations and utilization management. Familiarity with utilization review software, electronic health records (EHRs), and data analytics tools is essential, along with certifications such as Certified Utilization Review Specialist (CURN) or similar. Strong leadership, analytical thinking, and communication skills set top performers apart in collaborating with interdisciplinary teams and driving process improvements. These skills are vital for ensuring evidence-based, cost-effective care while maintaining regulatory compliance and optimizing patient outcomes.

What are some common challenges faced by Executive Nurse Practitioner Utilization Review professionals, and how can they be addressed?

Executive Nurse Practitioner Utilization Review professionals often encounter challenges such as balancing clinical judgment with organizational cost-containment goals, staying current with changing regulations and payer requirements, and effectively communicating decisions to both clinical teams and patients. To address these challenges, it's important to maintain strong collaboration with interdisciplinary teams, participate in ongoing education on healthcare policies, and develop excellent communication and negotiation skills. Leveraging technology and evidence-based guidelines can also help streamline the review process and support sound decision-making.

What is the difference between Executive Nurse Practitioner Utilization Review vs Nurse Practitioner Utilization Review?

AspectExecutive Nurse Practitioner Utilization ReviewNurse Practitioner Utilization Review
CredentialsMaster's or Doctorate in Nursing, Nurse Practitioner certification, additional leadership or executive trainingMaster's or Doctorate in Nursing, Nurse Practitioner certification
Work EnvironmentLeadership roles, strategic planning, policy development in healthcare organizationsClinical review, case assessments, utilization decisions in healthcare settings
Employer & Industry UsageHospitals, insurance companies, healthcare management firmsHospitals, clinics, insurance companies, utilization review organizations

The main difference is that Executive Nurse Practitioner Utilization Review professionals often hold leadership responsibilities, focusing on strategic and policy aspects, while Nurse Practitioner Utilization Review roles are more clinical, concentrating on case reviews and utilization decisions. Both roles require advanced nursing credentials, but the executive position involves additional management and organizational skills.

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Executive Nurse Practitioner Utilization Review jobs near you

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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