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Executive Nurse Practitioner Utilization Review Jobs

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization ...

New

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 ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

Miami Jewish Health

Utilization Review Nurse

Miami, FL · On-site

Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...

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All JobsNurse Practitioner Utilization Review JobsExecutive Nurse Practitioner Utilization Review Jobs

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 Aug 11, 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 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 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.

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 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.
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Executive Nurse Practitioner Utilization Review jobs near you

RN Utilization Review-Case Management-FT-1st shift

Huntsville Hospital Health System

Huntsville, AL • On-site

Other

This job post has expired today. Applications are no longer accepted.

Huntsville Hospital Health System rating

6.1

Company rating: 6.1 out of 10

Based on 207 frontline employees who took The Breakroom Quiz

728th of 887 rated healthcare providers

Job description

Overview
The Surgical Utilization Review Registered Nurse (UR RN) is responsible for conducting concurrent medical necessity reviews to ensure appropriate level-of-care determinations, regulatory compliance, and reimbursement integrity. This position serves as a liaison between physicians, advanced practice providers, nursing, case management, revenue cycle, and payer organizations to facilitate accurate patient status assignment, timely authorization management, and denial prevention.
The primary focus of this role is surgical utilization review, including pre-operative, post-operative, and procedural patient populations. Responsibilities include validating compliance with Medicare, commercial payer, and organizational requirements, including Inpatient Only (IPO) procedures, Two-Midnight Rule criteria, observation services, and medical necessity requirements.
This role requires strong collaboration with surgeons, physician assistants, nurse practitioners, hospitalists', and clinical staff to obtain clarifying documentation, facilitate timely order placement, and support appropriate status determinations. The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate.
Qualifications
Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse
Preferred Education: Bachelors Science Nursing or higher
Required Experience: 2 years previous nursing experience
Preferred Experience: Utilization Review or Case Management experience
Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse
Preferred License/Registration/Certification: ACM or CCM Certification
Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, Microsoft Suite and email applications.

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