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Nurse Practitioner Utilization Management Jobs (NOW HIRING)

UF Health

RN, Utilization Management

Saint Johns, FL · On-site

Registered Nurse (RN) license with 3+ years experience in utilization review or case management Necessary Skills • Knowledge of healthcare utilization guidelines and compliance • Experience ...

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $40.86/hr

Behavioral Health Utilization Review RN HealthCare Support is actively seeking a Remote BH Utilization Review RN to fill an opening with a Managed Care Company . Daily Responsibilities for Remote BH ...

UF Health

RN, Utilization Management

Saint Johns, FL · On-site

Registered Nurse (RN) license with 3+ years experience in utilization review or case management Necessary Skills • Knowledge of healthcare utilization guidelines and compliance • Experience ...

KA Recruiting Inc.

Nurse Practitioner

Marion, AR · On-site

Seeking a full time Nurse Practitioner to join a great team in Arkansas! This position will be ... utilization management activities; and assists with risk management functions

Intus Care

Contract Utilization Management Nurse

$42/hr

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care ...

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Nurse Practitioner Utilization Management information

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$71K

$134.4K

$210.5K

How much do nurse practitioner utilization management jobs pay per year?

As of Sep 12, 2026, the average yearly pay for nurse practitioner utilization management 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 the difference between Nurse Practitioner Utilization Management vs Nurse Practitioner Case Management?

AspectNurse Practitioner Utilization ManagementNurse Practitioner Case Management
CertificationsNP license, possibly certifications in utilization reviewNP license, case management certifications often preferred
Work EnvironmentInsurance companies, health plans, utilization review departmentsHospitals, clinics, outpatient facilities, patient advocacy
Employer & Industry UsagePrimarily in insurance and managed care organizationsHealthcare providers, hospitals, outpatient centers

Both roles involve patient care and clinical expertise, but Nurse Practitioner Utilization Management focuses on reviewing medical necessity and optimizing resource use, while Nurse Practitioner Case Management emphasizes coordinating patient care and discharge planning. Understanding these differences helps in choosing the right career path or job search focus.

What cities are hiring for Nurse Practitioner Utilization Management jobs?

Cities with the most Nurse Practitioner Utilization Management job openings:

What states have the most Nurse Practitioner Utilization Management jobs?

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

What are popular job titles related to Nurse Practitioner Utilization Management jobs?

For Nurse Practitioner Utilization Management jobs, the most frequently searched job titles are:

Nurse Practitioner Utilization Management jobs near you

RN - Utilization Management

Franklin, NH • On-site

Central Business Solutions
See more jobs at Central Business Solutionsexternal

Full-time

Re-posted 2 days ago

Job description

Utilization Management Registered Nurse (UM RN)
Job Summary
We are seeking an experienced and detail-oriented Utilization Management Registered Nurse (UM RN) to join our hospital team. The UM RN is responsible for reviewing patient cases to ensure appropriate utilization of healthcare services, medical necessity, compliance with payer requirements, and optimal patient outcomes. This role collaborates closely with physicians, case managers, and interdisciplinary teams to support quality patient care while managing healthcare resources efficiently.
Key Responsibilities
  • Perform utilization review activities for inpatient and outpatient services.
  • Assess medical necessity, level of care, and appropriateness of admissions using established criteria such as InterQual or MCG guidelines.
  • Collaborate with physicians, case management, and healthcare teams regarding patient care plans and discharge planning.
  • Communicate with insurance providers and third-party payers to obtain authorizations and resolve coverage issues.
  • Monitor patient length of stay and identify opportunities to improve care efficiency.
  • Ensure compliance with hospital policies, federal regulations, and payer requirements.
  • Document utilization review findings accurately and maintain confidentiality of patient information.
  • Participate in denial prevention and appeals processes when necessary.
  • Support quality improvement initiatives and patient care coordination activities.

Qualifications
  • Active Registered Nurse (RN) license in the applicable state.
  • Bachelor of Science in Nursing (BSN) preferred.
  • Minimum 2-3 years of acute care hospital nursing experience required.
  • Prior experience in Utilization Management, Case Management, or Care Coordination preferred.
  • Strong knowledge of InterQual and/or MCG criteria.
  • Experience working with electronic medical records (EMR) systems.
  • Excellent communication, critical thinking, and organizational skills.

Central Business Solutions, Inc(A Certified Minority Owned Organization)
Checkout our excellent assessment tool: http://www.skillexam.com/
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Central Business Solutions, Inc
37600 Central Court Suite 214 Newark CA, 94560
Phone: (833)247-8800 Fax: (510)-740-3677
Web: http://www.cbsinfosys.com

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