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Utilization Review Np Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Village Care

Utilization Review Nurse

Manhattan, NY · On-site

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

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 ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... all Utilization Management activities to include review of inpatient and outpatient medical ... nurse practitioners and other health workers involved in the care of a member Ability to meet ...

Mindlance

Utilization Review Nurse

Nashville, TN

... all Utilization Management activities to include review of inpatient and outpatient medical ... practitioners and other health workers involved in the care of a member • Ability to meet ...

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How much do utilization review np jobs pay per hour?

As of May 31, 2026, the average hourly pay for utilization review np in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Utilization Review Nurse Practitioner, and why are they important?

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

What are some common challenges Utilization Review Nurse Practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

What does a Utilization Review NP do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

What is the highest paid NP job?

The highest paid nurse practitioner (NP) roles are often in specialized fields such as anesthesiology, psychiatric-mental health, or neonatal care, with salaries exceeding $150,000 annually. NPs with advanced certifications, extensive experience, and in high-demand regions tend to earn the highest compensation, especially in hospital or surgical settings.

What is the difference between Utilization Review Np vs Utilization Review Nurse?

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

More about Utilization Review Np jobs
What cities are hiring for Utilization Review Np jobs? Cities with the most Utilization Review Np job openings:
What states have the most Utilization Review Np jobs? States with the most job openings for Utilization Review Np jobs include:
What job categories do people searching Utilization Review Np jobs look for? The top searched job categories for Utilization Review Np jobs are:
Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in the United States as of May 2026, with employment types broken down into 4% As Needed, 16% Full Time, 78% Part Time, 1% Contract, and 1% Nights. Highlights an 100% Physical job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV

Other

Posted 23 days ago

Job description

Fusion HCR is hiring! Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations
Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines
Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines
Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment
Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

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