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Utilization Review Np Jobs (NOW HIRING)

Global Force USA

Utilization Review Nurse

Las Vegas, NV · On-site

Utilization Review Nurse Location: Las Vegas, NV Willing to relocate to Las Vegas. With Benefits! Job Requirement Education/Experience: Graduation from an accredited school of nursing and five (5) ...

Cobalt Benefits Group

Utilization Review Nurse

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

ALOIS Healthcare

RN - Utilization Review

Pocatello, ID · 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.

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 ...

Seh

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 ...

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 ...

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 ...

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 ...

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 ...

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Utilization Review Np information

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How much do utilization review np jobs pay per hour?

As of Jul 14, 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 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 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 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.

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Utilization Review Np jobs near you
Utilization Review Nurse

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Posted 5 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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