Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Infusion Nurse Practitioner (NP)
Cary, NC · On-site
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Infusion Nurse Practitioner (NP)
Cary, NC · On-site
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Infusion Nurse Practitioner (NP)
Cary, NC · On-site
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Infusion Nurse Practitioner (NP)
Cary, NC · On-site
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Quick apply
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Join IVX Health as a Full-time Nurse Practitioner in our Raleigh, Durham and Cary clinics! Shift ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Join IVX Health as a Full-time Nurse Practitioner in our Raleigh, Durham and Cary clinics! Shift ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
As a Nurse Practitioner at IVX Health, you'll be at the forefront of delivering personalized ... review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical Workflows ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Utilization Manager
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Nurse Practitioner
$109K - $164K/yr
Nurse Practitioner (NP) / Physician Assistant (PA) About the Company Tenavi Staffing is partnering ... Complete medication reviews and reconciliation * Conduct cognitive, depression, and safety ...
Nurse Practitioner
$109K - $164K/yr
Nurse Practitioner (NP) / Physician Assistant (PA) About the Company Tenavi Staffing is partnering ... Complete medication reviews and reconciliation * Conduct cognitive, depression, and safety ...
Utilization Review Np information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do utilization review np jobs pay per hour?
As of Jul 27, 2026, the average hourly pay for utilization review np in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.
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 does a Utilization Review NP 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 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?
| Aspect | Utilization Review Np | Utilization Review Nurse |
|---|---|---|
| Credentials | Master's degree in Nursing, Nurse Practitioner certification, state licensure | Registered Nurse (RN) license, possibly with certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies, utilization review organizations | Hospitals, insurance companies, outpatient clinics |
| Job Responsibilities | Assess medical necessity, authorize treatments, make clinical decisions, often with greater autonomy | Review 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 Raleigh, NC? For Utilization Review Np jobs in Raleigh, NC, the most frequently searched job titles are:
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What job categories do people searching Utilization Review Np jobs in Raleigh, NC look for? The top searched job categories for Utilization Review Np jobs in Raleigh, NC are:
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What cities near Raleigh, NC are hiring for Utilization Review Np jobs? Cities near Raleigh, NC with the most Utilization Review Np job openings:
Granville Health System rating
8.6
Based on 5 frontline employees who took The Breakroom Quiz
Job description
Position Summary:
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.
What Granville Health System employees say
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Hours and flexibility
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