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Utilization Review Np Jobs in Decatur, AL (NOW HIRING)

Fast Pace Health

Family Nurse Practitioner

Huntsville, AL · On-site

$100 - $125/hr

Discuss and review patients' medical history, symptoms, allergies, and current medications ... Ability to perform responsibilities within standard NP protocols. * Responsible for learning the ...

Fast Pace Health

Family Nurse Practitioner

Huntsville, AL · On-site

$106K - $135K/yr

Discuss and review patients' medical history, symptoms, allergies, and current medications ... Ability to perform responsibilities within standard NP protocols. * Responsible for learning the ...

Fast Pace Health

Family Nurse Practitioner

Huntsville, AL · On-site

$105K - $133K/yr

Discuss and review patients' medical history, symptoms, allergies, and current medications ... Ability to perform responsibilities within standard NP protocols. * Responsible for learning the ...

SportsMed

Nurse Practitioner

Huntsville, AL · On-site

Review imaging, develop care plans, and coordinate smooth patient flow * Deliver clear, compassionate communication with patients and families * Work closely with a surgeon and team who value ...

NHS Management Services

Unit Manager RN (7a-3p)

Madison, AL · On-site

$34 - $45/hr

Assists in maintaining resident care standards by supervising and directing activities of subordinate nurses engaged in quality assurance, infection control, and utilization review activities.

NHS Management, LLC

Unit Manager RN (7a-3p)

Madison, AL · On-site

$37.50 - $49.50/hr

Assists in maintaining resident care standards by supervising and directing activities of subordinate nurses engaged in quality assurance, infection control, and utilization review activities.

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All JobsUtilization Review Np JobsUtilization Review Np Jobs in Decatur, AL

Utilization Review Np information

See Decatur, AL salary details

$20

$39

$64

How much do utilization review np jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for utilization review np in Decatur, AL is $39.64, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 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.

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Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Decatur, AL as of June 2026, with employment types broken down into 89% Full Time, 9% Part Time, 1% Temporary, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $82,446 per year, or $39.6 per hour.

Upperline Health Plus Nurse Practitioner Opportunity Madison AL| Value-Based Care

Upperline Health

Madison, AL • On-site

$91K - $125K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 5 days ago

Upperline Health rating

3.5

Company rating: 3.5 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

15k Sign-On Bonus
A Specialty Path to Good Health
Upperline Health is the nation's largest provider group dedicated to lower extremity, wound and vascular care. Founded in 2017 with the ambitious goal of transforming specialty care, Upperline Health is a pioneer in bringing value-based care models into specialty care. Upperline delivers a more efficient path for patients to receive consistent and effective treatment for chronic illnesses.
Triage is temporary.
Treatment is transformative.
Upperline Health providers coordinate patients' care among a team of specialists - physicians, advanced practice providers, care navigators, pharmacists, dieticians, and social workers for integrated treatment that addresses patients' immediate and long-term health needs.
We put patients at the center of value-based care.
Why join our team?
  • Highly competitive salary plus annual bonus opportunity
  • Generous benefit options include comprehensive medical, dental & vision, 401K, PTO and parental leave
  • Continuing Medical Education reimbursement
  • State license reimbursement
  • Highly supportive interdisciplinary team
  • Work Life Balance - regular weekday schedule
  • Rapidly growing company with potential leadership & career growth opportunities

About the Nurse Practitioner (APP) PositionUpperline Health is seeking a Nurse Practitioner to provide clinic-based care in our Madison, AL market. In collaboration with Upperline's local Physician team, APPs develop complex plans of care in accordance with the patient's health status and overall goals and values; provide medical diagnostics and treatments in the clinic, in the patient's home, or via telehealth, consistent with the APP's scope of practice and the patient's medical condition; educate patients and families on medication usage, diet & nutrition, and crisis anticipation & prevention. They will also communicate medical information to patients' physicians, other providers and Upperline's Physician team and broader interdisciplinary team.
Ideal candidates will have experience with the following: Primary Care/Internal Medicine, geriatric care and/or home-based care, Palliative or Hospice care and/or previously worked in a value-based care environment. Most importantly, candidates must demonstrate compassion for patient needs, have great attention to detail, and thrive in a collaborative environment with rapid growth.
This is a unique opportunity to make a meaningful impact and meet the needs of at-risk patients in both primary and specialty care, with a regular weekday schedule!
What You'll Do:
  • Develop and implement clinical plans of care for adult patients facing chronic conditions (e.g., diabetes, COPD, CHF, debility, dementia).
  • Gather patient history, physical exam, and diagnostics within a clinic setting, via telehealth, or within the patient's home.
  • Develop and implement treatment plans given patient's goals of care and current conditions.
  • Collaborate with the interdisciplinary team to meet the patient and family's physical as well as psychosocial needs.
  • Provide compassionate care for our complex patients and their families
  • Educate patients and families about medication usage, side effects, illness progression, diet & nutrition, medical adherence and crisis anticipation & prevention.
  • Communicate with other Upperline clinical team members as well as patient's community providers, to coordinate optimal care and resources for the patient and their family.
  • Communicate with Upperline's local physician to review patient records and care plans on a timely basis consistent with state regulations and company standards and policy.
  • Maintain patient medical records and medical documentation consistent with state regulations and company standards and policy.
  • Complete accurate and timely documentation according to risk adjustment standards per education provided.
  • Take part in weekly interdisciplinary team meetings and scheduled education sessions.
  • Provide telephonic support for escalated calls from triage nurse.
  • Participate in continuing education as required by the state Board of Nursing.
  • Prescribe medication as permitted by the state Board of Nursing.
  • Other related duties as deemed necessary.

Required Skills, Education, and Competencies:
  • Master's degree in nursing required
  • Board Certification as an Adult, Adult-Geriatric or Family Nurse Practitioner required
  • Current State Registered Nurse & Nurse Practitioner license required
  • Basic Life Support (BLS) certification is required
  • 2plus years (Over 4000 hours) nurse practitioner experience in Primary Care/Internal Medicine
  • Value-based care experience preferred
  • Possession of DEA registration or eligibility
  • Must be comfortable providing care in patients homes
  • Previous experience managing, supervising, or coaching clinicians highly preferred
  • A reliable automobile, valid driver's license and minimum state required liability auto insurance are required; Mileage reimbursement provided
  • Adaptability to thrive is a fast-paced growth-forward environment
  • Experience working in an EMR - AthenaHealth EMR is highly preferred
  • Proficiency using Microsoft Office products
  • Excellent oral and written communication skills to ensure that each of your interactions with patients, family caregivers, clinicians, and team members is effective and meaningful.

Compensation
Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience
Job Type: Full-time
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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