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Utilization Review Np Jobs in Utah (NOW HIRING)

Imh

Manager Utilization and Care Management

Murray, UT · On-site +1

$44.99 - $69.44/hr

Lead, supervise, and mentor a team of RN or Behavioral Health Care Managers and RN or Behavioral Health Utilization Review clinicians, and related support positions ensuring clinical excellence and ...

Deercreekseniorliving

Nurse Practitioner

Layton, UT · On-site

$110 - $130/hr

Communication * 1. Communicates and collaborates with the interdisciplinary group to create, review ... year Nurse Practitioner experience and a minimum of one (1) year hospice or palliative care ...

Amg-Senior-Medical-Group

Nurse Practitioner

Ogden, UT · On-site

$110 - $130/hr

The Nurse Practitioner provides home-based primary and palliative care to elderly, frail ... Develop and regularly review individualized care plans with patients, families, and caregivers.

University of Utah

PS Nurse Practitioner

Salt Lake City, UT · On-site

$12K - $141K/mo

... 2026 Priority Review Date (Note - Posting may close at any time) 09/04/2026 Job Summary The ... Licensure to practice as a Nurse Practitioner in the State of Utah. Nationally certified as a Nurse ...

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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.

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Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Utah as of August 2026, with employment types broken down into 80% Full Time, 15% Part Time, and 5% Contract. Highlights an 80% In-person, and 20% Remote job distribution.

Remote - Radiologist Utilization Review - 1099 (contract)

MRIoA

Salt Lake City, UT • On-site, Remote

Contractor

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Description
Flexible Independent Contractor (1099)
Require a DC or Maryland State Medical License
ABOUT MRIoA
Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally recognized Independent Review Organization (IRO) specializing in technology-driven utilization management and clinical medical review solutions. We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement.
THE OPPORTUNITY:
We are currently seeking Board-Certified physicians in RADIOLOGY to conduct independent Utilization Reviews. This is a flexible remote opportunity requiring just 1-2 hours per week-with no minimum commitment.
ADDITIONAL INFORMATION:
  • Work remotely from anywhere in the US (Per HIPAA Regulations, patient records cannot leave the US).
  • Covered under MRIoA's Errors and Omissions policy.
  • Independent Contractor (1099) opportunity.
  • Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

Requirements
  • Must have a Medical Degree MD or DO
  • Must have a current state medical license in DC or Maryland
  • Current Board Certification in Radiology
  • Must have 5 years of clinical experience residency to be included
  • Daytime availability is required for peer-to-peer conversations

California Consumer Privacy Act (CCPA) Information (California Residents Only):
  • Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver's license number, or state identification card number, and passport number.
  • Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.

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