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Full Time Nurse Practitioner Utilization Review Jobs

Albanymed

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

While performing utilization review identifies areas for clinical documentation improvement and ... Registered nurse with a New York State current license. Associate's degree required. Bachelor ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete Utilization Management (UM) process, from admission through discharge planning. The primary goal is ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full lifecycle of Independent Review Organization (IRO) cases, ensuring compliance with regulatory ...

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Full Time Nurse Practitioner Utilization Review information

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$71K

$134.4K

$210.5K

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

As of Aug 21, 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 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 are the key skills and qualifications needed to thrive as a full time nurse practitioner utilization review?

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 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 Registered Nurse

3B Healthcare, Inc.

Torrance, CA • Remote

Full-time

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

Job description

Registered Nurse – Utilization Review (Remote)This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS).Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable).InterQual experience is mandatory; candidates without this will not be considered.Proficient in Epic, with recent use within the last 6–12 months.Experience working with HMOs, IPAs, and similar managed care organizations.Strong knowledge of Medicare regulations and associated utilization management processes, including:Condition Code 44 (CC44)Advance Beneficiary Notices (ABNs)Hospital-Issued Notices of Noncoverage (HINNs)Medicare Coverage Status Notices (MCSNs)

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