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Utilization Review Np Jobs in Santa Rosa, CA (NOW HIRING)

Nurse Practitioner

Bolinas, CA · On-site

$127K - $173K/yr

Summary: The Nurse Practitioner will work at the top of their licensure and as part of a team of ... Demonstrate competent knowledge in delivering health care to patients through the peer review ...

Nurse Practitioner Opportunity Attention all Nurse Practitioners, we are calling you to partner ... Review health history, service member medical records, and medical questionnaires. * Interview ...

Nurse Practitioner

Santa Rosa, CA · On-site

$65 - $67/hr

Job Title: Nurse Practitioner Location: 2403 Professional Dr, Santa Rosa, CA Department: MAT ... Reviews PPD (TB test) results submitted by new hires that had test completed elsewhere within ...

Review health history, service member medical records, and medical questionnaires. * Interview ... Active NP license in the state * CPR/BLS Certification * Experience with Primary Care, Urgent Care ...

Review health history, service member medical records, and medical questionnaires. * Interview ... Active NP license in the state * CPR/BLS Certification * Experience with Primary Care, Urgent Care ...

Review health history, service member medical records, and medical questionnaires. * Interview ... Active NP license in the state * CPR/BLS Certification * Experience with Primary Care, Urgent Care ...

Showing results 21-40

Utilization Review Np information

See Santa Rosa, CA salary details

$23

$46

$75

How much do utilization review np jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for utilization review np in Santa Rosa, CA is $46.23, according to ZipRecruiter salary data. Most workers in this role earn between $36.54 and $53.08 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 Santa Rosa, CA are hiring for Utilization Review Np jobs?

Cities near Santa Rosa, CA with the most Utilization Review Np job openings:

Infographic showing various Utilization Review Np job openings in Santa Rosa, CA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, 5% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $96,155 per year, or $46.2 per hour.

Nurse Practitioner

Petaluma Health Center

Point Reyes Station, CA

$127K - $173K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago


Job description

Petaluma Health Center is recruiting for a Nurse Practitioner to join our award winning team!
Summary: The Nurse Practitioner will work at the top of their licensure and as part of a team of health care professionals to provide quality primary medical care in a compassionate and caring environment; provide health care services by performing the appropriate assessment including the history and physical exam, ordering appropriate diagnostic tests, and implementing therapeutic treatment in accordance with Petaluma Health Center’s standardized clinical procedures, policies, protocols, and guidelines under the supervision of a physician supervisor; work as an integral part of the clinical staff by participating in Medical Staff and PA/NP meetings as well as other projects and committees of Petaluma Health Center; and perform other duties as assigned, including but not limited to after-hours call, weekend clinics, and assignment to outside locations within PHC federal scope such as school based clinics.
Petaluma Health Center is an eleven-time award winner in the North Bay Business Journal's Best Places to Work for 2020, 2019, 2018, 2017, 2016, 2015, 2014, 2013, 2012, 2011 and 2009 and we were named as one of the Healthiest Companies in the North Bay' by the North Bay Business Journal for the last 5 consecutive years.
The Petaluma Health Center's mission is to provide high quality health care with access for all in Southern Sonoma County & West Marin. We pride ourselves on our Patient-Centered care while maintaining an engaging environment for our staff. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.

FULL TIME EMPLOYEE BENEFITS:

  • 21 Days of Paid Time Off
  • 10 Paid Holidays
  • Medical Insurance (Entire deductible paid by us!)
  • 30 Chiropractor and Acupuncture visits per year included with enrollment in our health insurance plans (Kaiser and WHA)
  • Dental Insurance
  • Vision Insurance
  • Gym Membership Discounts at Synergy Health Club and 24-Hour Fitness!
  • 401K Matching after 1 year of employment
  • Flexible Spending Account, Dependent Care FSA
  • Life Insurance (included at no cost to the employee)
  • Long Term Disability (included at no cost to the employee)
  • Employee Assistance Program (included at no cost to the employee)

Areas of Responsibility:

  • Take appropriate history and physical examination of patients , and evaluate and treat patients within the usual and customary scope of licensure, practice policies and guidelines, and national certification
  • Order pertinent diagnostics and implement appropriate therapy according to scope of practice guidelines
  • Obtain supervising physician's consultation when problems presented are outside scope of practice or when unfamiliar with a particular aspect of the patient's care according to the PA/NP Standardized Procedures
  • Communicate effectively with the patients while involved with their health care, including providing appropriate patient education while answering questions and in history taking
  • Demonstrate competent knowledge in delivering health care to patients through the peer review processes including chart review, by interactions with physician preceptors and by working collaboratively with support staff and all staff of PHC
  • Become an integral part of the clinical staff through participation in Medical Staff meetings, PA/NP meetings, and other committees of PHC
  • Maintain credentials by keeping all required licenses current, including but not limited to California Medical License, DEA licenses, CME hours, CPR Certifications and any other required licenses. It is the responsibility of the nurse practitioner to give Human Resources current credentials before old credentials expire
  • Willingly perform other duties within the scope of practice as assigned
  • Support and contribute to clinic efforts to maintain and improve patient satisfaction in all aspects of health delivery in a positive manner
  • Work at maximum potential to meet productivity requirements in order to improve patient access and fiscal viability while maintaining quality medical care
  • Meet all time commitments by arriving on time to the clinic and working an entire shift or more as needed
  • Abide by all Joint Commission Ambulatory Care requirements including, but not limited to, sensitivity to cultural diversity, patient care, patients' rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, compliance with National Patient Safety Goals, and licensure and health screenings.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Education/Experience:

  • Completion of a nationally accredited Nurse Practitioner Program
  • Three to five years of experience providing primary care in a family practice setting
  • Experience working in a NCQA Patient –Centered Medical Home (PCMH) Recognized organization; understanding of NCQA Level 3 (highest) PCMH recognition requirements highly preferred
  • Experience working in a Joint Commission Accredited health care organization; understanding of Joint Commission Ambulatory Care Accreditation requirements highly preferred.
  • Master’s Degree in Public Health, or related field highly preferred

Licenses and Certifications:

  • Current CA RN License in good standing
  • Current CA certification as a FNP or ANP
  • Current BLS
  • Candidate must be able to successfully meet PHC’s credentialing and privileging requirements

Language Skills: Ability to effectively present information and respond to questions and requests from patients, co-workers, and others as necessary. Bilingual in English and Spanish, both written and verbal preferred.
Salary Scale: $120,000 to $173,806 per year  
The compensation amounts listed above do not include relocation assistance, sign-on bonus, productivity or quality/service incentives, call pay, extra shift incentives, if applicable to the position.