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Utilization Review Np Jobs in Kansas (NOW HIRING)

Gentiva Hospice

Nurse Practitioner

Topeka, KS · On-site

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

The Little Clinic

Nurse Practitioner

Wichita, KS

Participate in peer review, quality assurance, and staff meetings with other health practitioners ... utilization of the clinic * Respond as directed by regional management to correct any situations ...

The Little Clinic

Nurse Practitioner

Wichita, KS · On-site

Participate in peer review, quality assurance, and staff meetings with other health practitioners ... utilization of the clinic * Respond as directed by regional management to correct any situations ...

The Little Clinic

Nurse Practitioner

Wichita, KS · On-site

Participate in peer review, quality assurance, and staff meetings with other health practitioners ... utilization of the clinic * Respond as directed by regional management to correct any situations ...

Gentiva

Hospice Nurse Practitioner

Topeka, KS · On-site

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

Gentiva Hospice

Hospice Nurse Practitioner

Topeka, KS

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

Gentiva Hospice

Hospice Nurse Practitioner

Topeka, KS · On-site

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

Life Spring Recovery

Nurse Practitioner

Andover, KS · On-site

Nurse Practitioner (NP) - PRN Location: LifeSpring Recovery Center - Andover, Kansas Status: PRN ... Participate in quality improvement initiatives and clinical review processes. Medical Leadership ...

Truhealth

Nurse Practitioner

Salina, KS · On-site

If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who ... For further information, please review the Know Your Rights notice from the Department of Labor.

TruHealth

Nurse Practitioner

Salina, KS

If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Utilization Review Np information

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 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 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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What job categories do people searching Utilization Review Np jobs in Kansas look for?

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Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Kansas as of August 2026, with employment types broken down into 2% Internship, 4% As Needed, 73% Full Time, 19% Part Time, and 2% Contract. Highlights an 87% In-person, 2% Hybrid, and 11% Remote job distribution.

Utilization Reviewer

Bert Nash Community Mental Health Center

Lawrence, KS • On-site

$65K - $70K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Bert Nash Community Mental Health Center rating

6.2

Company rating: 6.2 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

Utilization Reviewer
Pay is commensurate with experience within a range of $65,000 to $70,000 annually. Full time, exempt, benefits eligible. Bert Nash offers excellent benefits which include medical, dental, vision, KPERS retirement, life insurance, an Employee Assistance Program (EAP) providing free counseling and resources, and generous PTO.
Caring. Hope. Giving back. Our mission at the Bert Nash Center as the Community Mental Health Center (CMHC) of Douglas County is to advance the health of the community through comprehensive behavioral health services responsive to evolving needs and changing environments. We accomplish this by believing in our team. Each person that works for the Bert Nash Center contributes directly to the success of our clients, organization, and community. Our values of compassion, integrity, equity and hope reflect in everything we do.
The Utilization Reviewer's primary responsibility is to manage and complete monthly clinical record reviews to ensure provision of clinically appropriate care is delivered to clients in the least restrictive but clinically appropriate level as quickly as possible while complying with agency, payers, applicable policies, regulations and accreditation standards. This role's overall goal is to ensure that quality services are provided in the most efficient, cost-effective manner to all eligible clients seeking treatment regardless of the treatment setting or payer.
Responsibilities: The primary responsibility of the Utilization Reviewer is to ensure clinical documentation achieves expected standards, implement and train for consistency in best practices across the organization's facilities, participate and coordinate with teams Quality Improvement Plans or related initiatives. Duties will include but not limited to:
  • Conduct monthly clinical chart reviews to assure clients receive clinically appropriate care and complies with agency, payor, applicable policies, regulations and accreditation standards.
  • Utilize evidence-based calculation to ensure the sample size of charts reviewed provide a high confidence level that results are valid and reliable.
  • Provide chart review results to program directors or managers with both aggregate program data and individual charts needing remediation.
  • Work with directors or program managers on remediation activities to ensure they are completed within 30 days.
  • Meet with teams to help identify and develop continuous quality improvement goal(s) to improve the quality of documentation.
  • Managing organizational risks through implementation and improvement of best practices in clinical documentation, CCBHC regulations, CARF standards and other regulatory requirements.
  • Provide or coordinate the provision of related trainings in collaboration with the Clinical Consultant, Clinical Educator, and other team members.
  • Provides response to clinical quality questions.
  • Champions continuous quality improvement and assists in developing, tracking, and realizing related organizational goals or objectives.
  • Assign, analyze and present the quarterly chart review data for all teams per CARF Standards 2.G. and 2.H.
  • Analyzes monthly chart reviews to identify both areas needing improvement and areas that have improved since previous audits.
  • Maintain and record inventories of chart review occurrences and results.
Qualifications include but not limited to:
  • Licensure in social work, counseling, nursing or psychology.
  • Knowledge and familiarity with electronic health record (EHR) documentation.
  • Three years of experience providing billed services to clients in fields such as nursing, counseling, psychology, therapy, medication management, case management, or other.
  • Master's degree in behavioral health, medical services or administration, nursing, psychology, sociology, or similar.
  • Ability to accurately interpret standards from policies, contracts, and accrediting bodies for implementation.
  • Flexibility in assigned working hours.
  • Ability to negotiate, complete contracted work, analyze operations, and governmental/accrediting body regulations.
  • Interest or experience in quality improvement, quality assurance, or similar background and/or training a plus.
  • Have exemplary existing skills in clinical documentation and familiarity with using EHRs to complete documentation reviews, as well as external tools such as the Microsoft Office Suite.
  • Assist QI team with other duties as needed.

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