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Full Time Nurse Practitioner Utilization Review Jobs

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

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 ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

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 ...

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 ...

Tenet Health

Nurse Practitioner- Cardiology

Phoenix, AZ · On-site

Biltmore Cardiology is seeking a full-time Nurse Practitioner or Physician Assistant to join our ... Assists the physician as follows, but not limited to Utilization Review, Quality Assurance, Program ...

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All JobsNurse Practitioner Utilization Review JobsFull Time Nurse Practitioner Utilization Review Jobs

Full Time Nurse Practitioner Utilization Review information

See salary details

$71K

$134.4K

$210.5K

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

As of Aug 1, 2026, the average yearly pay for full time 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 a Full Time Nurse Practitioner Utilization Review, and why are they important?

To excel as a Full Time Nurse Practitioner in Utilization Review, you need advanced clinical knowledge, strong analytical abilities, and a current NP license, often complemented by experience in case management or utilization review. Familiarity with utilization management systems, electronic health records (EHRs), and industry certifications such as CCM (Certified Case Manager) or URAC accreditation is valuable. Exceptional communication, critical thinking, and attention to detail set top performers apart in this role. These skills ensure appropriate, cost-effective patient care decisions while maintaining compliance with regulatory standards and optimizing healthcare resource utilization.

How does a Nurse Practitioner in Utilization Review typically collaborate with other healthcare professionals to ensure effective patient care?

As a Nurse Practitioner specializing in Utilization Review, you will work closely with physicians, case managers, insurance representatives, and other members of the healthcare team to assess the necessity and efficiency of patient care plans. Frequent collaboration is required to review medical records, provide clinical input on treatment appropriateness, and facilitate communication between providers and payers. This teamwork helps ensure patients receive quality care that meets both clinical and regulatory standards while managing healthcare resources responsibly.

What is the difference between Full Time Nurse Practitioner Utilization Review vs Full Time Physician Utilization Review?

AspectFull Time Nurse Practitioner Utilization ReviewFull Time Physician Utilization Review
CredentialsRegistered Nurse (RN) with Nurse Practitioner certificationMedical Degree (MD or DO) and medical license
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, healthcare facilities
Employer & Industry UsageCommonly employed in insurance and healthcare organizations for review rolesOften employed in similar settings for medical review and decision-making
Work FocusAssessing medical necessity, reviewing patient records, applying clinical guidelinesEvaluating complex medical cases, making clinical judgments, approving or denying services

While both roles involve utilization review, Nurse Practitioners focus on applying clinical guidelines with nursing expertise, whereas Physicians provide in-depth medical assessments. The choice depends on the complexity of cases and organizational needs.

What does a Full Time Nurse Practitioner Utilization Review do?

A Full Time Nurse Practitioner Utilization Review is responsible for assessing the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review clinical documentation, apply evidence-based criteria, and collaborate with healthcare providers to ensure patients receive the most appropriate care. Their work helps manage healthcare costs, prevent unnecessary procedures, and maintain quality standards within healthcare organizations. This role combines clinical expertise with administrative and analytical skills to support optimal patient outcomes.
What cities are hiring for Full Time Nurse Practitioner Utilization Review jobs? Cities with the most Full Time 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 Full Time Nurse Practitioner Utilization Review jobs? States with the most job openings for Full Time Nurse Practitioner Utilization Review jobs include:
Full Time Nurse Practitioner Utilization Review jobs near you

Utilization Review Nurse

Access Healthcare Staffing & Recruitment

Las Vegas, NV • On-site

Full-time

Re-posted 24 days ago

Job description

Salary: $40-$63

Utilization Review Nurse (RN)

Las Vegas, NV | Full-Time

Salary: $40 $63/hour


Position Summary

Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards.


Requirements:

Education/Experience:

  • Graduate of an accredited nursing program
  • 5+ years of acute care nursing experience
  • At least 1 year in Utilization Management, Case Management, or CDI
  • Minimum 3 years of Utilization Management experience
  • 3+ years of discharge planning experience in acute care


Licensure:

  • Active Nevada RN license


Additional Requirements:

  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman criteria


Key Skills & Knowledge

  • Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines
  • Chart review and clinical documentation analysis
  • Regulatory compliance and hospital standards
  • Strong communication, collaboration, and analytical skills


Work Environment

  • Office-based with extended sitting and computer use
  • May require shifts and weekends