Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Licensed Associate Professional Registered Nurse credentialed from the Alabama Board of ...
Utilization Review * Schedule: PRN Days * Work Location: UAB ST Vincent's Birmingham * Benefits for ... Licensed Associate Professional Registered Nurse credentialed from the Alabama Board of ...
Nurse Practitioner
Foley, AL · On-site
$125 - $150/hr
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
New
Nurse Practitioner
Foley, AL · On-site
$125 - $150/hr
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
New
Nurse Practitioner
Rainbow City, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Rainbow City, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
American Traveler is hiring an experienced RN Case Manager to support complex case management ... and utilization review, • Familiarity with InterQual criteria, CMS guidelines, DRG, HIPAA, and ...
American Traveler is hiring an experienced RN Case Manager to support complex case management ... and utilization review, • Familiarity with InterQual criteria, CMS guidelines, DRG, HIPAA, and ...
American Traveler is hiring a Travel RN Case Manager for a hospital setting requiring 1+ year of recent case management/utilization review experience and an active FL or compact RN license. Job ...
American Traveler is hiring a Travel RN Case Manager for a hospital setting requiring 1+ year of recent case management/utilization review experience and an active FL or compact RN license. Job ...
Academic Fellows, Residents and Certified Registered Nurse Practitioners also provide world-class, disease-specific care in this area under the supervision of the attending MD.Multidisciplinary ...
Academic Fellows, Residents and Certified Registered Nurse Practitioners also provide world-class, disease-specific care in this area under the supervision of the attending MD.Multidisciplinary ...
Specialty Clinic Telephone Nurse Gastrointestinal Clinic
Birmingham, AL · On-site
$60 - $80/hr
Academic Fellows, Residents and Certified Registered Nurse Practitioners also provide world-class, disease-specific care in this area under the supervision of the attending MD. Multidisciplinary ...
New
Specialty Clinic Telephone Nurse Gastrointestinal Clinic
Birmingham, AL · On-site
$60 - $80/hr
Academic Fellows, Residents and Certified Registered Nurse Practitioners also provide world-class, disease-specific care in this area under the supervision of the attending MD. Multidisciplinary ...
New
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Jasper, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Foley, AL · On-site
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Rainbow City, AL · On-site
$100 - $125/hr
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Hospice Nurse Practitioner
Rainbow City, AL · On-site
$100 - $125/hr
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...
Utilization Review Np information
What does a utilization review nurse practitioner 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 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 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?
| Aspect | Utilization Review Np | Utilization Review Nurse |
|---|---|---|
| Credentials | Master's degree in Nursing, Nurse Practitioner certification, state licensure | Registered Nurse (RN) license, possibly with certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies, utilization review organizations | Hospitals, insurance companies, outpatient clinics |
| Job Responsibilities | Assess medical necessity, authorize treatments, make clinical decisions, often with greater autonomy | Review 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.
What are popular job titles related to Utilization Review Np jobs in Alabama?
For Utilization Review Np jobs in Alabama, the most frequently searched job titles are:
- Work From Home Infectious Disease Nurse Practitioner
- Remote Acute Care Nurse Practitioner
- Palliative Care Np
- Evening Addiction Nurse Practitioner
- Virtual Nurse Practitioner Home Assessments
- Longevity Nurse Practitioner
- Short Term Contract Nurse Practitioner
- Afternoon Labor Delivery Nurse Practitioner
- Home Assessment Nurse Practitioner
- Travel Nurse Practitioner
What job categories do people searching Utilization Review Np jobs in Alabama look for?
The top searched job categories for Utilization Review Np jobs in Alabama are:
- Family Nurse Practitioner Bc
- Fbi Nurse Practitioner
- Flex Time 1099 Nurse Practitioner
- Team Health Nurse Practitioner
- Temporary Indian Health Nurse Practitioner
- Temporary Good Faith Exams Nurse Practitioner
- Director Visa Sponsorship Nurse Practitioner
- Entry Level Nurse Practitioner Loan Forgiveness
- Temporary Concierge Nurse Practitioner
- Nurse Practitioner Relocation Package
What cities in Alabama are hiring for Utilization Review Np jobs?
Cities in Alabama with the most Utilization Review Np job openings:
Per diem
Medical, PTO
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Job description
Position Overview
- Department: Utilization Review
- Schedule: PRN Days
- Work Location: UAB ST Vincent's Birmingham
- Benefits for eligible positions only include: generous paid time off, paid parental leave, Associate Assistance Program, Tuition Reimbursement Program, and more
Provide health care services regarding admissions, case management, discharge planning and utilization review.
- Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
- Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
- Assess and coordinate discharge planning needs with healthcare team members.
- May prepare statistical analysis and utilization review reports as necessary.
- Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
Licensure / Certification / Registration:
- Licensed Associate Professional Registered Nurse credentialed from the Alabama Board of Nursingobtained prior to hire date or job transfer date required.
Education:
- Diploma from an accredited school/college of nursing and required professional licensure at time of hire.
- One Year of Experience is required
No additional preferences.
About UAB St. Vincent'sUAB St. Vincent's, a proud part of UAB Medicine, is a trusted provider of health care, serving Alabama for more than 125 years. With five hospitals and numerous clinics, we're a health care community deeply rooted in compassion, service, and respect for all, guided by the rich legacy of the St. Vincent's name. We're committed to extending kindness and personalized care to patients, their families, and each other. We address the physical, psychological, social, and spiritual needs of our patients. We believe in the power of teamwork and unity, and foster a collaborative spirit among our more than 4,800 employees. As one of Alabama's best hospitals as recognized by U.S. News & World Report, improving the health and lives of those we serve is at the heart of our mission. Join us in continuing our legacy of service and healing in central Alabama, where we can make a lasting impact together.
Employment Type: OTHER