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Utilization Review Np Jobs in Boca Raton, FL (NOW HIRING)

Nurse Practitioner page is loaded## Nurse Practitionerremote type: On-Sitelocations: West Palm ... Regularly reviews chronic medical conditions that require ongoing medical attention on office ...

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Utilization Review Np information

See Boca Raton, FL salary details

$20

$40

$65

How much do utilization review np jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review np in Boca Raton, FL is $40.12, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.06 per hour, depending on experience, location, and employer.

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 near Boca Raton, FL are hiring for Utilization Review Np jobs?

Cities near Boca Raton, FL with the most Utilization Review Np job openings:

Nurse Practitioner

Cano Health, LLC

West Palm Beach, FL • On-site

$80 - $120/hr

Other

Re-posted 17 days ago


Cano Health rating

7.6

Company rating: 7.6 out of 10

Based on 10 frontline employees who took The Breakroom Quiz


Job description

Nurse Practitioner page is loaded## Nurse Practitionerremote type: On-Sitelocations: West Palm Beach, FLtime type: Full timeposted on: Posted Todayjob requisition id: JR4119It's rewarding to be on a team of people that truly believe in making an impact!We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.**Job Summary**Under the direction of a licensed physician, provides medical services to patient using approved patient care protocols; collect and document data, conduct diagnostic and therapeutic procedures, order and schedule laboratory studies and professional consultations and provides direct patient care services. Formulates and implements treatment and therapeutic plans for hospitalized patients.**Duties & Responsibilities****Essential Duties & Responsibilities*** Provides comprehensive clinical primary patient care through interviewing, examining and establishing treating plan for patients to meet their health and wellness needs.* Prescribes appropriate medical treatment and clinical medications consistent with Medical Standards for patients and orders studies, tests, and ancillary care services as required* Creates medically appropriate referrals* Follows all established rules and guidelines of evidence-based care and best clinical practice* Documents all services in electronic patient medical record* Regularly reviews chronic medical conditions that require ongoing medical attention on office visits.* Educates patients on wellness, prevention, and early detection by discussion and /or providing materials and resources to the patients and families* Provides routine office injections SQ, IM, or Intraarticular as per standards of care for primary care providers and Cano Health care standards.* Consults/collaborates with Cano Health Physician as needed regarding patient care, assessment, and education issues in patients with complicated medical conditions.* Maintains privacy and confidentiality of all patient information according to federal and state guidelines, regulations and HIPAA.**Additional Duties & Responsibilities*** Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.**Supervisory Responsibilities*** No supervisory responsibilities.**Education & Experience*** Master's Degree in Nursing* 1+ years' nursing experience* Valid nurse practitioner license* Ability to work within a team and take direction* Must be familiar with the EHR medical charting system* Basic Life Support (BLS) Certification required; must maintain active certification throughout employment.* Strong written and interpersonal communication skills* Experience with eCW highly preferred**Knowledge, Skills & Proficiencies*** The ideal candidate will have at least three years' experience, the ability to work independently and experience working with an Electronic Medical Record (EMR).**Job Requirements****Physical Requirements**This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.**Travel Requirements****Travel Required****Amount of Expected Travel****Details**Work will involve some driving/traveling to assigned clinics.**Tools & Equipment Used**Computer and peripherals, standard and customized software applications and tools, and usual office equipment.**Disclaimer**The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.Join our team that is making a difference!Please see Cano Health's Notice of E-Verify Participation and the Right to Work postTogether, we have the opportunity to serve and grow with purpose. Find your team and begin your journey of transforming healthcare! #J-18808-Ljbffr

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