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Nurse Practitioner Utilization Review Jobs (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... This position is responsible for performing initial, concurrent review activities; discharge care ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2.8K/wk

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 Shift ...

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Nurse Practitioner Utilization Review information

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$71K

$134.4K

$210.5K

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

As of Jun 16, 2026, the average yearly pay for 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 in the Nurse Practitioner Utilization Review position, and why are they important?

To thrive as a Nurse Practitioner Utilization Review, you need advanced clinical knowledge, current NP licensure, and expertise in reviewing medical records for appropriateness of care. Familiarity with utilization management software, ICD-10/CPT coding, and case management systems is typically required, along with relevant certifications such as URAC or CCM. Strong analytical thinking, attention to detail, effective written communication, and collaboration skills help you excel in evaluating care plans and working with multi-disciplinary teams. These abilities ensure accurate assessment of healthcare services, optimal resource use, and regulatory compliance within healthcare organizations.

What are common day-to-day responsibilities for a Nurse Practitioner Utilization Review?

A Nurse Practitioner Utilization Review typically spends their day evaluating patient records, determining medical necessity of treatments, and ensuring care meets established guidelines and payer requirements. This role involves frequent collaboration with physicians, case managers, and insurance representatives to clarify or appeal decisions as needed. You may also participate in team meetings, develop recommendations for optimizing utilization, and provide education to clinical staff regarding documentation or policy changes. The work is often remote or office-based, with a predictable schedule and minimal direct patient contact. This structure allows for a balanced workload and a focus on analytical aspects of patient care.

What is a Nurse Practitioner Utilization Review job?

A Nurse Practitioner Utilization Review (NP UR) job involves evaluating medical records to ensure treatments are medically necessary, cost-effective, and compliant with healthcare guidelines. NP UR professionals work with insurance companies, healthcare organizations, or government agencies to review patient care decisions, approve or deny claims, and recommend alternative treatments when needed. They use clinical expertise to assess whether services align with best practices and healthcare policies. This role is typically non-clinical, involving case reviews, documentation, and collaboration with healthcare providers. It helps improve patient care efficiency while controlling costs.

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Nurse Practitioner Utilization Review jobs near you
Infographic showing various Nurse Practitioner Utilization Review job openings in the United States as of June 2026, with employment types broken down into 6% As Needed, 82% Full Time, 6% Part Time, and 6% Contract. Highlights an 78% In-person, and 22% Remote job distribution, with an average salary of $134,369 per year, or $64.6 per hour.
Utilization Review Nurse

Utilization Review Nurse

Rising Medical Solutions

Chicago, IL • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement

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

Job description

Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!
**This is a full-time position - 40 hours per week (Must work M-F each day).
Responsibilities
  • Perform all aspects of the Utilization Review Process
  • Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
  • Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review
  • Write nurse summaries on all UR files
  • Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR
  • Establish collaborative relationships with clients, patients, employers, providers and attorneys
  • Track ongoing status of all UR activity so that appropriate turn-around times are met
  • Maintain organized files containing clinical documentation of interactions with all parties of every claim
  • Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
  • Respond to various written and telephonic inquiries regarding status of case
  • Must be proficient in the use of a computer, including the use of various software programs simultaneously

Requirements
  • An Associate's or Bachelor's degree in Nursing
  • Hold an active and unencumbered RN license in one or more states
  • 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
  • More than one state license (a plus)
  • Experience with Workers' Compensation, short-term or long-term disability, or liability claims
  • The ability to set priorities and work both autonomously and as a team member
  • Well-developed time-management, organization, and prioritization skills
  • Excellent analytical skills
  • Superb oral and written communication
  • The ability to gather data, compile information, and prepare summary reports
  • Strong interpersonal and conflict resolution skills
  • Experience in a fast-paced, multi-faceted environment
  • Demonstrated persistence and attention to detail
  • General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
  • Working knowledge of: Microsoft Word, Excel, and Outlook
  • Ability to remain calm during stressful situations
  • A customer-service mindset

Benefits
    • Generous Flexible Time Off (take it when you need it!)
    • Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
    • Career Growth Opportunities - We often promote from within
    • Professional Development Reimbursement Program (PDRP)
    • You will be part of our new Elevate program designed to recognize and reward employees for their hard work
    • Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions Top Workplaces
    • We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical
    • Want to see more? Check out our:
      • Facebook: https://www.facebook.com/RisingMedicalSolutions
      • LinkedIn: http://www.linkedin.com/company/rising-medical-sol..

If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!

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