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 ...
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 ...
Utilization Review Nurse
Omaha, NE · On-site
Utilization Review Nurse We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective ...
Utilization Review Nurse
Omaha, NE · On-site
Utilization Review Nurse We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective ...
Utilization Review Nurse Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities include: * Review and evaluate electronic medical records of ...
New
Utilization Review Nurse Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities include: * Review and evaluate electronic medical records of ...
New
Travel Utilization Review
Tuba City, AZ · On-site
Reliable Nurse Staffing is seeking a travel Utilization Review for a travel job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: Therapy * Start Date: 09/07/2026
Travel Utilization Review
Tuba City, AZ · On-site
Reliable Nurse Staffing is seeking a travel Utilization Review for a travel job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: Therapy * Start Date: 09/07/2026
Utilization Review Nurse
Syracuse, NY · On-site
Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a R ecruiting ...
Utilization Review Nurse
Syracuse, NY · On-site
Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a R ecruiting ...
Utilization Review Nurse
Las Vegas, NV · On-site
About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...
Utilization Review Nurse
Las Vegas, NV · On-site
About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ...
Utilization Review
Marlboro, NJ · On-site
Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Utilization Review
Marlboro, NJ · On-site
Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Utilization Review Nurse
North Charleston, SC · On-site
Utilization Review Nurse Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and ...
New
Utilization Review Nurse
North Charleston, SC · On-site
Utilization Review Nurse Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and ...
New
Utilization Review Nurse
$28.85 - $31.25/hr
Provide outpatient or pharmacy services utilization review Qualifications * Current Florida RN License * 3+ years in recent medical/surgical or critical care experience * 3+ years of Utilization ...
Utilization Review Nurse
$28.85 - $31.25/hr
Provide outpatient or pharmacy services utilization review Qualifications * Current Florida RN License * 3+ years in recent medical/surgical or critical care experience * 3+ years of Utilization ...
Utilization Review Nurse
Omaha, NE · On-site
The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective, efficient, and in accordance with applicable legal requirements. This is a full-time, permanent ...
Utilization Review Nurse
Omaha, NE · On-site
The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective, efficient, and in accordance with applicable legal requirements. This is a full-time, permanent ...
Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Quick apply
Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...
RN - Utilization Review
Tuba City, AZ · On-site
RN - Utilization Review Prime HealthCare Staffing, a national health care staffing company with over 20 years in the business, is looking for an experienced RN - Utilization Review for our customer ...
RN - Utilization Review
Tuba City, AZ · On-site
RN - Utilization Review Prime HealthCare Staffing, a national health care staffing company with over 20 years in the business, is looking for an experienced RN - Utilization Review for our customer ...
RN - Utilization Review
Tuba City, AZ · On-site
$2.5K/wk
Details Client Name Tuba City Regional - Tuba City, AZ - Medefis Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 37695957 Job Title RN - Utilization Review Weekly ...
RN - Utilization Review
Tuba City, AZ · On-site
$2.5K/wk
Details Client Name Tuba City Regional - Tuba City, AZ - Medefis Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 37695957 Job Title RN - Utilization Review Weekly ...
Utilization Review
Tuba City, AZ · On-site
RN - Utilization Review Excel is seeking highly skilled healthcare professionals for travel assignments across the United States. As a travel healthcare professional, you will have the opportunity to ...
Utilization Review
Tuba City, AZ · On-site
RN - Utilization Review Excel is seeking highly skilled healthcare professionals for travel assignments across the United States. As a travel healthcare professional, you will have the opportunity to ...
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 ...
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 ...
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 ...
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 ...
AZ - Utilization Review RN
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 ...
AZ - Utilization Review RN
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 ...
Utilization Review
Marlboro, NJ · On-site
Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Utilization Review
Marlboro, NJ · On-site
Work collaboratively with Admissions, Clinical, Nursing, and Billing departments. * Verify ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Utilization Review RN
Eureka, CA · On-site
$1.9K/wk
Details Client Name Providence Health and Services Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay ...
New
Utilization Review RN
Eureka, CA · On-site
$1.9K/wk
Details Client Name Providence Health and Services Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay ...
New
Nurse Practitioner Utilization Review information
See salary details
$71K - $83.7K
3% of jobs
$83.7K - $96.4K
7% of jobs
$96.4K - $109K
12% of jobs
$110K is the 25th percentile. Wages below this are outliers.
$109K - $121.7K
34% of jobs
$121.7K - $134.4K
9% of jobs
$145.4K is the 75th percentile. Wages above this are outliers.
$134.4K - $147.1K
12% of jobs
$147.1K - $159.8K
6% of jobs
$159.8K - $172.5K
5% of jobs
$172.5K - $185.1K
5% of jobs
$185.1K - $197.8K
3% of jobs
$197.8K - $210.5K
3% of jobs
$71K
$134.4K
$210.5K
How much do nurse practitioner utilization review jobs pay per year?
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?
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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Job description
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 UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. There will be interaction with providers, patient, and the care team for continued UM process. Further job duties will include Denial prevention, denial management, Implementation of process improvements to mitigate payer denials & improve front-end processes, Collaboration with internal Physician Advisor and external physician advisors regarding physician practices (particularly documentation deficiencies/admission practices). This individual identifies, develops, and provides orientation, and training, for appropriate staff and colleagues on an ongoing basis. He/she actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. This individual maintains current and accurate knowledge regarding commercial and government payers and CIHQ regulations/guidelines/criteria related to UM. The UR Nurse effectively and efficiently manages a diverse workload in a dynamic regulatory environment. The UR Nurse is a member of, and provides support to, the hospital’s UR Committee. He/she collaborates with multiple leaders at various levels throughout Shannon Health, for the purpose of supporting and improving the UM program.
Qualifications
Education
- Required
- High School Diploma, GED, or equivalent
- Associate’s degree in Nursing
- Preferred
- Bachelor’s degree in Nursing
Experience:
- Required
- Five years of experience in Clinical Nursing
- Preferred
- Three years of experience in Inpatient Utilization Review
Certification/Licensure:
- Required
- Registered Nurse (RN), with authorization to practice in the State of Texas
- Preferred
- Accredited Case Manager (ACM) through ACMA
- Certified Case Manager (CCM) through CCMC
About Shannon Health
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