ZipRecruiter

Log In

1

Utilization Review Np Jobs (NOW HIRING)

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Penn Medicine

Utilization Review Nurse

West Chester, PA · On-site

The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License? About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

IntePros

Utilization Review Nurse

Philadelphia, PA · On-site

PA RN License Required We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine ...

University of Utah

Utilization Review Nurse

Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...

previous pagenext page

Showing results 21-40

All JobsHealthcare JobsNursing JobsNurse Case Manager JobsUtilization Review Np Jobs

Utilization Review Np information

See salary details

$21

$42

$68

How much do utilization review np jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review np in the United States is $42.28, 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 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.

More about Utilization Review Np jobs

What cities are hiring for Utilization Review Np jobs?

Cities with the most Utilization Review Np job openings:

What states have the most Utilization Review Np jobs?

States with the most job openings for Utilization Review Np jobs include:

What job categories do people searching Utilization Review Np jobs look for?

The top searched job categories for Utilization Review Np jobs are:

Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

AbsoluteCare

New Orleans, LA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 19 days ago

Job description

Description
AbsoluteCare offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many of whom suffer from behavioral health, substance use, and SDoH challenges. We use population health management tools to employ a holistic approach to caring for the highest utilizers of healthcare services in our comprehensive care centers and in the community. AbsoluteCare tends exclusively to the needs of the top four to six percent of the population who persistently represent a disproportionate amount of unnecessary utilization and cost, regardless of whether they are engaged with other PCPs. In our more than 20 years of service, AbsoluteCare has focused on fulfilling the needs of this population. And we have consistently achieved unprecedented outcomes by addressing medical and psychosocial issues, in addition to the hardships of life that can exacerbate chronic health conditions and complicate access to care.
Our Values:
  • Accountability - We have the integrity to do what we say we will do
  • Caring - The needs of our team and members matter
  • Trust - Our members can rely on us
  • Teamwork - We act together as one inclusive group

Description:
The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with health plans and different providers/care teams to help ensure inpatient bed days and associated discharge/transitional care plans are appropriate. The Utilization Review Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity and appropriateness of treatment setting by utilizing the applicable policies and guidelines. Utilizes decision making and critical thinking skills in the review and determination of coverage for medically necessary health care services. Is part of a team that accountable for facilitating and providing care coordination services and associated quality outcomes for patients across the continuum of discharge planning and transitional care. Collaborates with different teams to develop and/or implement comprehensive discharge care plans based on assessment of member's clinical and social needs.
  • Reviews and interprets medical records and compares against industry guidelines and company policies to determine medical appropriateness and necessity of care.
  • Apply critical thinking and decision-making skills to determine if the medical record documentation supports the need for service while maintaining quality standards.
  • Continuously reviewing the patients' medical record to ensure that members will not receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.
  • As needed, perform onsite of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies.
  • Understands key aspects of discharge planning, transitional care management and drivers of readmissions when coordinating care for complex, vulnerable populations.
  • Ability to work with multidisciplinary teams and embrace teamwork.
  • Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness
  • Demonstrates proficiency with case load and the ability to manage complex cases effectively
  • Works with less structured, more complex issues and ability to identify solutions to non-standard requests and problems.
  • Demonstrates a solid understanding of managed care, Medicare, and Medicaid regulations.
  • Schedule: Monday thru Friday daytime hours, along with rotating weekends and holidays.

Experience
  • Ability to interpret clinical data.
  • Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is required to practice.
  • Bachelor's Degree in Nursing from an accredited school of nursing
  • Understanding of complex vulnerable populations and their associated care coordination needs.
  • Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®
  • Experience and knowledge with Medicaid and Medicare managed care organizations, regulations and populations.
  • Must have excellent oral, written, and interpersonal communication skills, and must be a creative problem solver.
  • Proven ability to meet deadlines and work under pressure.
  • Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
  • 3-5 years of acute care clinical experience required working in any of the following areas: ER, Critical Care, ICU, Ortho, Med Surg, Telemetry.
  • Health plan, ACO or IPA experience.

Our employeesare offered the following benefits
  • Free parking
  • Free Vision Plan
  • Medical and Dental plans
  • Life Insurance
  • Short Term Disability
  • 401 k Retirement plan

AbsoluteCare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

Apply