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Utilization Review Np Jobs in Rome, GA (NOW HIRING)

Longevity Health Plan

RN Field Coordinator

Calhoun, GA · On-site

Communicate with patients, families, and physicians as delegated by nurse practitioners. * Lead ... Participate in clinical meetings and contribute to hospitalization review sessions. * Perform ...

Longevity Health Plan

RN Field Coordinator

Calhoun, GA · On-site

Communicate with patients, families, and physicians as delegated by nurse practitioners. * Lead ... Participate in clinical meetings and contribute to hospitalization review sessions. * Perform ...

US Navy

Registered Nurse

Rome, GA

... a nurse practitioner, nurse anesthetist, or other advanced practice nurse when appropriately ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

US Navy

Registered Nurse

Rockmart, GA

... a nurse practitioner, nurse anesthetist, or other advanced practice nurse when appropriately ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

US Navy

Registered Nurse

White, GA

... a nurse practitioner, nurse anesthetist, or other advanced practice nurse when appropriately ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

US Navy

Registered Nurse

Summerville, GA

... a nurse practitioner, nurse anesthetist, or other advanced practice nurse when appropriately ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

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All JobsUtilization Review Np JobsUtilization Review Np Jobs in Rome, GA

Utilization Review Np information

See Rome, GA salary details

$21

$42

$69

How much do utilization review np jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review np in Rome, GA is $42.30, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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 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 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 are popular job titles related to Utilization Review Np jobs in Rome, GA? For Utilization Review Np jobs in Rome, GA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Np jobs in Rome, GA look for? The top searched job categories for Utilization Review Np jobs in Rome, GA are:
What cities near Rome, GA are hiring for Utilization Review Np jobs? Cities near Rome, GA with the most Utilization Review Np job openings:
Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Rome, GA as of July 2026, with employment types broken down into 77% Full Time, 15% Part Time, 7% Contract, and 1% Nights. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $87,987 per year, or $42.3 per hour.

Medical Assistant (Outpatient Clinic)

Highland Rivers Behavioral Health

Cedartown, GA

$16.25 - $21/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Highland Rivers Behavioral Health rating

7.1

Company rating: 7.1 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

There is a place for you at Highland Rivers Behavioral Health!

Highland Rivers provides treatment and recovery services to individuals impacted by mental illness; substance use disorders and intellectual developmental disabilities.

Are you ready to make a Difference?

JOB SUMMARY: The Medical Assistant (MA) will serve as liaison for the individual. The MA will complete an array of support tasks such as communication via patient portal, medication prior authorizations, return phone calls to individuals and assist the Outpatient Nurse Manager.

Duties and Responsibilities include:

  • Electronically send/receive records to/from individuals' PCPs. Documents within EHR all contacts/attempted contacts with PCPs.
  • Uploads in the EHR, individuals' lab results, ensuring results are shared with the clinic nurse/NP/MD. Also sends the lab results to the individual via mail or within the patient portal.
  • Sends health communications to individuals via the patient portal and responds to individuals' questions/inquiries received through the patient portal.
  • Completes any medication prior authorizations or patient assistance applications the Doctor/NP needs completed.
  • Returns phone calls to individuals DAILY when they have questions/problems about their medications/lab results/etc.
  • As needed assists the Outpatient Nurse Manager with tasks such as managing the medical supplies within the clinic's medication room/nursing office, completing reviews/audits, etc.

Benefits:

  • Health Insurance through the State Health Benefit Plan of GA
  • Flexible Benefits such as dental, vision, life, critical illness, etc.
  • Retirement Plan with employer matching
  • 4 weeks of Paid Time Off with increase of accruals based on years of service
  • 10 paid holidays
  • 1 personal day
  • Qualifying employer for Public Student Loan Forgiveness

What Highland Rivers Behavioral Health employees say

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