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Utilization Review Np Jobs in Virginia (NOW HIRING)

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Showing results 21-40

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 cities in Virginia are hiring for Utilization Review Np jobs?

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

Infographic showing various Utilization Review Np job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

$145K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 12 days ago


Job description

Overview

Location:ย Naval Medical Center, Portsmouth, VA

Department: Neurology Clinic

Work Schedule:ย Monday - Friday from 0700-1800

Pay: $145,600/year

Benefits:ย PTO, holiday leave, Life, Accidental Death and Dismemberment, Short Term Disability

Optional Benefits:ย Medical, Dental, Vision, 401(K) matching with employee participation in 401(K) plan

Responsibilities
  • Analyze the results of the health care plan, modify the plan as needed, and participate in follow-up.

  • Participate in meetings to review and evaluate patient care, identify opportunities for improvement, and recommend corrective actions when necessary.

    • If meetings occur outside of regular working hours, HCW must read and initial the meeting minutes.

  • Participate in monthly in-service training for non-health care staff on subjects related to the HCW's specialty.

  • Provide an optimum physical environment for patients and staff, emphasizing safety and cleanliness.

  • Support preventive maintenance and promptly report equipment failures or inadequacies.

  • Promote economic utilization of equipment and supplies, and be cost-conscious when ordering laboratory and radiological studies.

  • Know the location and operation of emergency equipment.

  • Adhere to departmental and hospital safety guidelines.

Nurse Practitioner (Neurology) - Additional Duties:

  • Evaluate and treat patients with headaches, including new evaluations and follow-ups, in accordance with detailed practice guidelines and standard operating procedures.

    • Neurologists will always be present and available; oversight provided as needed.

  • Collaborate with patients and families to achieve therapeutic goals.

  • Evaluate and treat beneficiaries presenting to the Neurology Clinic and sub-clinics for acute, routine, wellness, and follow-up visits; refer to staff internist as appropriate.

  • Obtain patient health and developmental history.

  • Perform and record health appraisals, including physical assessments and evaluations.

  • Differentiate between normal findings and those requiring consultation or referral.

  • Diagnose common acute conditions, illnesses, or minor trauma in accordance with legally accepted protocols, Nurse Practice Acts, or BUMEDINST 6550.10B CH-1 (or subsequent instructions).

  • Formulate health care plans that emphasize self-care responsibility and involve the patient, family, physician, and other health care professionals.

  • Identify resources and coordinate referrals for patients and families requiring further evaluation and services, in collaboration with the medical preceptor and clinic manager.

  • Assist in staff education.

  • Provide nursing intervention and health care services through counseling and education.

  • Promote best business practices using evidence-based medicine.

  • Collect and record all examination data in the appropriate format for physician review, approval, and/or recommendation.

  • Help maintain positive interdepartmental relations through effective communication and work coordination.

  • Assist in systematically monitoring the effectiveness of practice through client databases and outcomes evaluation.

  • Perform and attend required training according to departmental policy, including semiannual skills fair meetings.

Qualifications
  • Education: Nurse Practitioners must be graduates of an academic program in their nursing specialty that is accredited by either the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE). A Master's degree in Nursing is required. The Contractor may not request an equivalency determination as a substitute for this education requirement.
  • Experience: Nurse Practitioners must possess a minimum of two years of experience within the last three years working as an Adult, Family, or Medical/Surgical Nurse Practitioner in an outpatient setting.
  • Licensure: Nurse Practitioners must maintain current, full, active, and unrestricted licensure as a Registered Nurse. In addition, they must hold and maintain certification as a Family or Medical/Surgical Nurse Practitioner through either ANCC or AANP.
  • Certifications: In addition to Basic Life Support (BLS) certification required by the base contract, Nurse Practitioners must hold and maintain board certification as a Family or Medical/Surgical Nurse Practitioner. Acceptable certifying bodies include the American Nurses Credentialing Center (ANCC), the American Academy of Nurse Practitioners (AANP), or another nationally recognized nursing certification organization appropriate to the specialty area, such as the National Certification Board of Pediatric Nurse Practitioners and Nurses, the American Nurses Association, or the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Specialties.
  • Additional Requirements: Candidates are required to provide two letters of recommendation written within the last two years. At least one letter must be from a physician or supervisor who has personally observed and evaluated the practitioner's clinical skills. The second letter may be from a clinic or hospital administrator, physician, or nurse with direct knowledge of the practitioner's patient care skills in a similar environment. Each letter must attest to the individual's clinical abilities, communication skills, professionalism, and interpersonal skills with staff and patients. Letters must include the name, title, phone number, date, address, and signature of the individual providing the recommendation.

Kako'o Services LLC

Kako'o Services is a premier provider of healthcare workers to various military treatment facilities across the United States. With a corporate office in Honolulu, Hawaii and recruiting office in San Antonio, Texas we specialize in providing skilled, trained and highly successful healthcare workers, including RNs, CRNAs, Physicians, LPN/LVN, Licensed Social Workers, and many more.

We have a strong focus on providing our government customers with quality and superior service.

Kako'o Services is an equal opportunity employer. For further information, please click the link to view the "Know Your Rights: Workplace Discrimination is Illegal" poster.

Know Your Rights: Workplace Discrimination is Illegal

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, protected veteran status, or other characteristics protected by law.

Only qualified individuals who are being considered will be contacted for an interview.

Employment Type: FULL_TIME