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Freelance Nurse Practitioner Utilization Review Jobs

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

New

Acrisure

Utilization Review Nurse

Bradenton, FL

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

New

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

New

Bestica Healthcare

RN Utilization Review

Tuba City, AZ · On-site

... nurse practitioners, nurse midwives, CRNA, and community health medics. Position Summary The ... Utilization Review (UR) Nurse ensures that patients receive appropriate care by verifying medical ...

Penn Medicine

Utilization Review Nurse

West Chester, PA · On-site

The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...

Tuba City Regional

Utilization Review

Tuba City, AZ · On-site

Utilization Review Nurse City/State: Tuba City, Arizona Shift: Monday - Friday from 8am - 5pm. Callback on weekends/holidays Contract Length: 13 weeks Start Date: 09/07/2026 The Utilization Review ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

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 ...

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All JobsNurse Practitioner Utilization Review JobsFreelance Nurse Practitioner Utilization Review Jobs

Freelance Nurse Practitioner Utilization Review information

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$71K

$134.4K

$210.5K

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

As of Aug 17, 2026, the average yearly pay for freelance 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 a freelance nurse practitioner utilization review?

A Freelance Nurse Practitioner Utilization Review is a nurse practitioner who works independently to assess the necessity, appropriateness, and efficiency of healthcare services, procedures, and treatments. They review patient records, insurance claims, and medical documentation to ensure that care provided meets established guidelines and is medically necessary. Working as a freelancer means they are not tied to a single employer and may contract with various hospitals, insurance companies, or healthcare organizations. This role helps control healthcare costs and ensures patients receive appropriate care without unnecessary procedures.

What is the difference between Freelance Nurse Practitioner Utilization Review vs Freelance Nurse Practitioner Case Management?

AspectFreelance Nurse Practitioner Utilization ReviewFreelance Nurse Practitioner Case Management
CredentialsRN, Nurse Practitioner, Certification in Utilization ReviewRN, Nurse Practitioner, Case Management Certification
Work EnvironmentInsurance companies, third-party review organizations, healthcare facilitiesHospitals, insurance companies, healthcare agencies, community health programs
Employer & Industry UsagePrimarily used for reviewing medical necessity and insurance claimsFocused on coordinating patient care, discharge planning, and resource allocation

Freelance Nurse Practitioner Utilization Review involves evaluating medical records to determine insurance coverage and necessity, while Freelance Nurse Practitioner Case Management centers on coordinating patient care and resources. Both roles require similar credentials but serve different functions within healthcare and insurance industries.

What are the key skills and qualifications needed to thrive as a freelance nurse practitioner utilization review, and why are they important?

To thrive as a Freelance Nurse Practitioner Utilization Review, you need advanced clinical knowledge, a nurse practitioner license, and experience in case management or utilization review. Familiarity with electronic medical record (EMR) systems, interqual or MCG guidelines, and relevant utilization review software is typically required. Strong analytical thinking, attention to detail, and clear written and verbal communication skills help set you apart in this role. These competencies ensure accurate and efficient evaluation of medical necessity, compliance with regulations, and effective collaboration with healthcare stakeholders.

What are some common challenges faced by freelance nurse practitioner utilization reviewers, and how can they be managed?

Freelance nurse practitioner utilization reviewers often encounter challenges such as managing fluctuating workloads, staying updated with constantly changing healthcare regulations, and ensuring timely communication with insurance companies and healthcare providers. To address these, it's helpful to establish a structured daily schedule, use project management tools to track cases, and participate in ongoing education or professional forums. Building strong relationships with clients and maintaining clear documentation also helps streamline the review process and manage expectations.

What cities are hiring for Freelance Nurse Practitioner Utilization Review jobs?

Cities with the most Freelance Nurse Practitioner Utilization Review job openings:

What are the most commonly searched types of Nurse Practitioner Utilization Review jobs?

The most popular types of Nurse Practitioner Utilization Review jobs are:

What states have the most Freelance Nurse Practitioner Utilization Review jobs?

States with the most job openings for Freelance Nurse Practitioner Utilization Review jobs include:

Freelance Nurse Practitioner Utilization Review jobs near you

Utilization Review Nurse

Maniilaq Association

Kotzebue, AK • On-site

Other

Posted 14 days ago

Job description

Maniilaq Association is a P.L. 93-638 Native/Indian Preference/EEO Employer
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Utilization Review Nurse Job Code: 2026:OTZ-201 Location: Kotzebue, Alaska Program: Nursing Division FT/PT Status: Full Time Job Responsibilities:
MANIILAQ ASSOCIATION
5/2026
Title: Utilization Management Nurse Pay Grade: 31
Program: Nursing Status: Exempt
Housing Priority: 3 Covered: Yes
POSITION SUMMARY
The Utilization Management Nurse (UMN) is responsible for performing Utilization Review and managing risk, coordinates and facilitates with departmental staff on Durable Medical Equipment (DME), and pharmacy prior authorizations. THE UMN works with the medical treatment and case management team in the coordination of patient care including the development of new operational changes and new services to ensure compliance and risk mitigation. The UMN will use a process that includes screening and case finding, comprehensive multidimensional assessment, connection with available resources, implementation of the plan and ongoing monitoring and re-assessment/follow-up. The UMN assists with the Quality and Case Management programs and, coordinates the IPC4 program. This position reports directly to the Chief Nursing Officer or designee.
PRINCIPAL DUTIES AND RESPONSIBILITIES
  1. Coordinates the IPC4 process in Medicare/Medicaid and private insurances.
  2. Assists in revenue procurement by:making sure insurance approvals are completed correctly with no penalty; helping to identify alternate resources of funding such as VA, Denali Kid Care, Medicare, and Medicaid; and monitoring the appeal process when claims are denied.
  3. Chairs Quarterly Utilization Review Committee meetings to improve utilization of resources and improve patient care.
  4. Submits Quarterly reports to CMO and CNO for Board of Director meetings.
  5. Works closely with Coders and Billers to insure accurate, timely billing information.
  6. Completes Utilization Review processes as assigned.
  7. Oversees development and maintenance of a resource database of Federal, State, community, and institutional resources.
  8. Assists in arranging team conferences and networks for relationship building and resource development with village leaders, Community Health Aides/Practitioners, MHC Medical Staff, MHC Nursing Staff, private insurance contacts, Medicaid/Medicare contacts, ANMC Providers, and the CM/SC/UR Team.
  9. Participates on improvement projects as assigned.
  10. Participates in Medicaid Task Force committee through Alaska Native Health Board.
  11. Completes Quality Improvement, Quality Assurance and Performance Improvement projects and tasks as assigned.
  12. Utilizes team building, problem solving skills and lean principles in the on-going quality improvement initiatives.
  13. Identify, assess, and monitor potential clinical, operational, and compliance risks within the Utilization Review and Case Management programs.
  14. Report and document incidents, near-misses, and adverse events in accordance with organizational policy and regulatory standards.
  15. Participate in root cause analyses and collaborate with leadership to implement corrective action plans to mitigate future risks.
  16. Collaborate with the Risk Management team to review, update, and communicate policies and procedures relevant to utilization review and patient care coordination.
  17. Educate clinical and administrative staff on risk awareness, safety protocols, and compliance requirements.
  18. Coordinate and facilitate prior authorizations for DME by collaborating with patients, clinical staff and providers to ensure clients' needs are met.
  19. Collaborate with providers and pharmacist process prior authorizations for specialized high-cost medications; monitor appeal process if claims are denied.
Job Qualifications:
MINIMUM REQUIREMENTS
Current licensure as a RN with at least two years of Case Management, Utilization Review, Discharge Planning or Quality Improvement experience preferred. Knowledge of acute and chronic illnesses, specialty clinic procedures, and community health nursing. Must be able to pass the core competencies assigned to this position and maintain the educational requirements of the program. Ability to utilize various computer programs, including Cerner and Microsoft Office. Demonstrates a wide theory base in order to interact in an effective manner with physicians, health team members, community agencies, and clients/families with diverse opinions, values, and religious and cultural ideals. Ability to work autonomously with little direction and be directly accountable for practice. Knowledge of and experience working with all regulatory, state, and federal agencies.
Other Job Information (if applicable):
DISCLAIMER
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be considered an exhaustive list of all responsibilities, duties and skills required of personnel in this job, and the employer reserves the right to revise or change this description. This description does not constitute a written or implied contract of employment. To perform this job successfully, an individual must be able to satisfactorily perform each of the above essential duties and meet physical demands. Reasonable accommodations may be made to enable individuals with disabilities to meet those conditions.

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