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Utilization Review Np Jobs in Minnesota (NOW HIRING)

Ourhrconnect

Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate ...

New

Ourhrconnect

Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate ...

New

Legacy Medical

Nurse Practitioner (NP)

Brainerd, MN · On-site

We are currently looking for a Nurse Practitioner (NP) with at least three years of nursing ... For further information, please review the Know Your Rights notice from the Department of Labor.

Nexus HR Services

Nurse Practitioner

Mankato, MN

$80 - $85/hr

Nurse Practitioner Compensation: $80 to $85 hourly Flexibility to make your schedule for single ... Extended 60-minute appointments allow for comprehensive chart review & physical examinations. No ...

Nexus HR

Nurse Practitioner

Mankato, MN · On-site

$80 - $85/hr

Nurse Practitioner Compensation: $80 to $85 hourly Flexibility to make your schedule for single ... Extended 60-minute appointments allow for comprehensive chart review & physical examinations. No ...

Vivian Health

MDS RN Nurse in Royalton, MN

Royalton, MN · On-site

$10K/mo

MDS - RN Nurse - Woodland - FT - Days Careers With Purpose Join our not-for-profit organization that has provided over 100 years of housing and services to seniors with a commitment to quality care ...

Nexus HR

Nurse Practitioner

Mankato, MN · On-site

$80 - $85/hr

Nurse Practitioner Compensation: $80 to $85 hourly Flexibility to make your schedule for single ... Extended 60-minute appointments allow for comprehensive chart review & physical examinations. No ...

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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?

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.

What are popular job titles related to Utilization Review Np jobs in Minnesota?

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

The top searched job categories for Utilization Review Np jobs in Minnesota are:

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Cities in Minnesota with the most Utilization Review Np job openings:

Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Minnesota as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 3% Contract, and 2% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Manager (RN) - Utilization Review

Hennepin Healthcare

Minneapolis, MN • On-site

Full-time

Re-posted 11 days ago

Hennepin Healthcare rating

7.6

Company rating: 7.6 out of 10

Based on 42 frontline employees who took The Breakroom Quiz

191st of 891 rated healthcare providers

Job description

Hennepin Healthcare is an integrated system of care that includes HCMC, a nationally recognized Level I Adult Trauma Center and Level I Pediatric Trauma Center and acute care hospital, as well as a clinic system with primary care clinics located in Minneapolis and across Hennepin County. The comprehensive healthcare system includes a 473-bed academic medical center, a large outpatient Clinic & Specialty Center, and a network of clinics in the North Loop, Whittier, and East Lake Street neighborhoods of Minneapolis, and in the suburban communities of Brooklyn Park, Golden Valley, Richfield, and St. Anthony Village. Hennepin Healthcare has a large psychiatric program, home care, and operates a research institute, philanthropic foundation, and Hennepin EMS. The system is operated by Hennepin Healthcare System, Inc., a subsidiary corporation of Hennepin County.
Equal Employment Opportunities: We believe equity is essential for optimal health outcomes and are committed to achieve optimal health for all by actively eliminating barriers due to racism, poverty, gender identity, and other determinants of health. We are committed to equitable care and working in an environment that celebrates, promotes, and protects diversity, equity, inclusion, and belonging. We are committed to bringing in individuals with new cultural perspectives to assist in creating a more equitable healthcare organization.
JOB DETAILS
Department: Utilization Management
FTE: 1.0 (80 hours per pay period)
Shift(s): Days
Location: Remote with onsite presence as needed
Current List of non-MN States where Hennepin Healthcare is an Eligible Employer: Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, North Carolina, North Dakota, New Mexico, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin.
We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a full-time management role with remote capability.
Purpose of this position: Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, financial, and utilization goals through effective management, communication, and role modeling. Functions as the internal resource on issues related to the appropriate utilization of resources, coordination of payer communication, and utilization review and management. Responsible for carrying out duties in a manner to assure success in financial management, human resources management, leadership, quality, and operational management objectives. Participates in program development and UR Department performance improvement. Responsible for day-to-day operations of the department, assists with the budgeting process, assists with personnel recruitment, retention, corrective action, and professional development.
RESPONSIBILITIES:
  • Participates in the development and management of department budgets and productivity targets
  • Directs and manages team of UR Coordinators, promotes employee satisfaction, supports staff development, and utilizes the progressive discipline process when appropriate
  • Collaborates with department director and professional development specialist to develop standard work and expectations for the utilization review process, including timely medical necessity screening to ensure patients are placed at the appropriate patient status and level of care, professional communication with physicians and nurses and other members of the care team
  • Collaborates with nursing, physicians, admissions, fiscal, legal, compliance, coding, and billing staff to answer clinical questions related to medical necessity and patient status
  • Ensures processes are in place for proactive reviews of surgical and other procedures to confirm accurate perioperative pre-authorization and patient class order reconciliation process. Assesses compliance to regulatory and health plan requirements for authorization, including Medicare
    Inpatient Only List and communicates to provider to obtain accurate order prior to procedure and post procedure
  • Ensures UR Coordinators and Clinical Coordinators identify, document, and communicate avoidable days and delays in services that may prolong length of stay; analyzes data to monitor trends for opportunities to improve services. Partners with hospital Director Transitional Care to report avoidable days, trends, and actions to UR Committees, as appropriate
  • Partners with Physician Advisor to engage in second level review and working with attending physicians to document completely to ensure patient class determinations
  • Serves as expert resource for all Medicare Notification Letters and ensures appropriate distribution of all letters (IMM, MOON, HINN, etc.) including full documentation to meet regulatory requirements and ensure correct billing
  • Works collaboratively with Inpatient Care Management, Patient Accounting, Patient Admission and Registration, HIM, and the Finance Department to analyze one-day Medicare inpatient stays and identify opportunities to improve
  • Develops and implements process to manage and respond to all concurrent and post-discharge third party payer denials of outpatient and inpatient cases alleged to be medically inappropriate. Including, but not limited to; Peer-to-Peer as appropriate, written appeal letters when indicated, documentation of interventions and outcomes and monitor to identify opportunities to improve processes for denial
    prevention
  • Serves as the internal expert on documentation and reimbursement requirements. Serves as a resource to the health care team for utilization and denial management. Liaises with provider office staff and facilitates meetings with payers, as appropriate
  • May participate in the Utilization Review Committee to present medical necessity data and outcomes and partners with care management leadership to develop action plans for improvement
  • Performs other duties as assigned

QUALIFICATIONS:
Minimum Qualifications:
  • Bachelors degree in nursing or related field
  • Three to five (3 to 5) years of leadership experience (i.e., charge nurse, team leader, preceptor, committee chair, etc.)
  • Five (5) years clinical experience.
  • A minimum of one (1) year of utilization review experience

Preferred Qualifications:
  • Masters' degree
  • CPHM (Certified Professional in Healthcare Management), CCM (Certified Case Manager), or ACM (Accredited Case Manager)
  • Experience in surgery, emergency and/or critical care
  • Experience in process/quality improvement, quality measurement, data abstraction, data analysis and reporting, and data integrity

Knowledge/ Skills/ Abilities:
  • Ability to deliver financial results for areas of accountability
  • Knowledge of or ability to learn financial management related to UR function and reporting, quality improvement processes, and human
    resources management
  • Able to effectively monitor, evaluate and administer the resources of each assigned area, and make substantiated recommendations regarding
    resource allocation needs for future planning purposes
  • Able to communicate effectively in writing and verbally, ability to interact with a wide variety of individuals, and handle complex and confidential
    situations
  • Ability to lead, delegate, analyze information and problem solve
  • Demonstrates evidence of strong skills in confidentiality, integrity, creativity, and initiative

License/Certifications:
  • Current Registered Nurse licensure from the Minnesota Board of Nursing upon hire

You've made the right choice in considering Hennepin Healthcare for your employment. We offer a wealth of opportunities for individuals who want to make an impact in our patients' lives. We are dedicated to providing Equal Employment Opportunities to both current and prospective employees. We are driven to connect talented individuals with life-changing career opportunities, enabling you to provide exceptional care without exception. Thank you for considering Hennepin Healthcare as a future employer.
Please Note: Offers of employment from Hennepin Healthcare are conditional and contingent upon successful clearance of all background checks and pre-employment requirements.

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