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Contract Occupational Therapy Utilization Review Jobs

Sentara Health Plans

$65 - $85/hr

... benefits, and contracts. Responsible for written and/or verbal notification to members and ... therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the ...

Pediatric Home Service

Occupational Therapist

Lakeland, FL · On-site

$37.50 - $49.50/hr

Contract Occupational Therapist Pediatric Health Choice (PPEC) Pediatric Health Choice is a leading ... Collaborate with the interdisciplinary team during care planning and progress reviews * Ensure ...

Pediatric Health Choice

Occupational Therapist

Lakeland, FL · On-site

$37.50 - $49.50/hr

Contract Occupational Therapist - Pediatric Health Choice (PPEC) Pediatric Health Choice is a ... Collaborate with the interdisciplinary team during care planning and progress reviews * Ensure ...

Pediatric Health Choice

Occupational Therapist

Lakeland, FL · On-site

$35.75 - $47/hr

Contract Occupational Therapist - Pediatric Health Choice (PPEC) Pediatric Health Choice is a ... Collaborate with the interdisciplinary team during care planning and progress reviews * Ensure ...

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All Jobsfreelance JobsContract Occupational Therapy Utilization Review Jobs

Contract Occupational Therapy Utilization Review information

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$23

$45

$67

How much do contract occupational therapy utilization review jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for contract occupational therapy utilization review in the United States is $45.37, according to ZipRecruiter salary data. Most workers in this role earn between $38.70 and $50.96 per hour, depending on experience, location, and employer.

What is a contract occupational therapy utilization review?

A Contract Occupational Therapy Utilization Review is a specialized role in which an occupational therapist evaluates the medical necessity, appropriateness, and efficiency of occupational therapy services provided to patients, typically for insurance or healthcare organizations. This position is usually contract-based, meaning the therapist is hired for a specific period or project rather than as a full-time employee. The main goal is to ensure that therapy services meet clinical standards and adhere to payer guidelines, helping to control costs and improve patient outcomes. Occupational therapists in this role review documentation, recommend approvals or denials for services, and may collaborate with providers to clarify treatment plans.

What are the key skills and qualifications needed to thrive as a contract occupational therapy utilization review specialist?

To excel in Contract Occupational Therapy Utilization Review, you need a solid background in occupational therapy, a current OT license, and experience with clinical documentation and case review. Familiarity with utilization management software, medical coding (ICD-10, CPT), and knowledge of insurance guidelines are typically required. Attention to detail, critical thinking, and strong written communication skills help professionals make sound, evidence-based determinations and collaborate with providers. These competencies ensure accurate, timely reviews that support appropriate patient care and regulatory compliance.

What are some common challenges faced in a contract occupational therapy utilization review role, and how can they be managed?

One common challenge in a Contract Occupational Therapy Utilization Review role is balancing the need to ensure care appropriateness with insurance guidelines and regulatory requirements. Professionals in this position often need to review clinical documentation thoroughly and communicate effectively with both therapists and insurance representatives to clarify recommendations and coverage. Managing tight deadlines and adapting to evolving healthcare policies can also be demanding. Staying organized, keeping up-to-date with current guidelines, and fostering strong professional relationships can help manage these challenges successfully.

What is the difference between Contract Occupational Therapy Utilization Review vs Contract Occupational Therapy Case Manager?

AspectContract Occupational Therapy Utilization ReviewContract Occupational Therapy Case Manager
Primary RoleReviewing therapy requests for medical necessity and appropriatenessCoordinating patient care, discharge planning, and therapy services
Work EnvironmentInsurance companies, healthcare facilities, telehealthHospitals, clinics, outpatient centers
CredentialsOccupational therapy license, possibly certifications in utilization reviewOccupational therapy license, case management certification often preferred

While both roles involve occupational therapy, Contract Occupational Therapy Utilization Review focuses on evaluating therapy requests for necessity, whereas Contract Occupational Therapy Case Managers coordinate ongoing patient care and discharge planning. Understanding these distinctions helps professionals choose the right career path or job opportunity.

What cities are hiring for Contract Occupational Therapy Utilization Review jobs?

Cities with the most Contract Occupational Therapy Utilization Review job openings:

What are the most commonly searched types of Occupational Therapy Utilization Review jobs?

The most popular types of Occupational Therapy Utilization Review jobs are:

What states have the most Contract Occupational Therapy Utilization Review jobs?

States with the most job openings for Contract Occupational Therapy Utilization Review jobs include:

Contract Occupational Therapy Utilization Review jobs near you

UTILIZATION REVIEW NURSE

Sentara Health Plans

On-site

$65 - $85/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Job description

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Education
  • BSN (preferred)
Certification
  • Registered Nurse (required)
Experience
  • 3 years of acute care clinical experience (required)
  • Previous Utilization Review experience (preferred)
  • Milliman experience (preferred)
  • Knowledge of NCQA (preferred)
  • Microsoft suite (Word, Excel, Outlook) (preferred)
Keywords

Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA

Benefits

Caring For Your Family and Your Career

  • Medical, Dental, Vision plans
  • Adoption, Fertility and Surrogacy Reimbursement up to $10,000
  • Paid Time Off and Sick Leave
  • Paid Parental & Family Caregiver Leave
  • Emergency Backup Care
  • Long-Term, Short-Term Disability, and Critical Illness plans
  • Life Insurance
  • 401k/403B with Employer Match
  • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
  • Student Debt Pay Down – $10,000
  • Pet Insurance
  • Legal Resources Plan

Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan.

The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!

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