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Nurse Practitioner Utilization Review Jobs (NOW HIRING)

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 ...

Cobalt Benefits Group

Utilization Review Nurse

Utilization Review Nurse Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse, you'll play an important role in ...

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 ...

Global Force

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 ...

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

... the Utilization Review Plan for Randolph Hospital. Review patient record and plan of care at ... Graduate from an accredited school of nursing. BSN preferred. Current license to practice as a ...

Harlem Hospital

RN - Utilization Review

Manhattan, NY · On-site

RN - Utilization Review About the Position Specialty: RN - Utilization Review Experience: 2+ years of experience in utilization review, case management, or acute care nursing License: Active State or ...

Albany Medical College

$77K - $119K/yr

## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full ... Minimum Qualifications:** • Registered nurse with a New York State current license. • Associate ...

Orison Solutions

RN - Utilization Review

New York, NY

$65 - $70/hr

Job Summary We are seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and level of care for patients. The RN will review clinical ...

UCI Health

RN - Utilization Review

Orange, CA · On-site

Utilization Review Nurse A utilization review nurse is a registered nurse (RN) who is responsible for ensuring patients receive necessary care without performing unnecessary or duplicate services.

Discovery Institute

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 ...

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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 Sep 12, 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 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.

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 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.

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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 September 2026, with employment types broken down into 83% Full Time, and 17% Contract. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $134,369 per year, or $64.6 per hour.

Utilization Review Nurse

Big Spring, TX • On-site

Shannon Health
Nursing and Residential Care Facilities • 1 - 5K employees
Learn more about Shannon Healthexternal

Full-time

Re-posted 19 days ago

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

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