Canton, MA · On-site
$55 - $60/hr
$55-$60 per hour Canton, MA Contract Duration: 6 Month Contract (Possibility of Extension) Position ... Perform outpatient utilization management (UM) and medical necessity reviews for prior ...
Canton, MA · On-site
$55 - $60/hr
$55-$60 per hour Canton, MA Contract Duration: 6 Month Contract (Possibility of Extension) Position ... Perform outpatient utilization management (UM) and medical necessity reviews for prior ...
Norfolk, VA · On-site +1
The Utilization Review Nurse is responsible for utilization management services within the scope of ... benefits, and contracts. Responsible for written and/or verbal notification to members and ...
Norfolk, VA · On-site +1
The Utilization Review Nurse is responsible for utilization management services within the scope of ... benefits, and contracts. Responsible for written and/or verbal notification to members and ...
Troy, MI · On-site
Contract: 1-2 months (possibility of going longer depending on business needs) Company /Day to Day ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Troy, MI · On-site
Contract: 1-2 months (possibility of going longer depending on business needs) Company /Day to Day ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Ensures contract outcome measures are met with emphasis on utilization management. * Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
Ensures contract outcome measures are met with emphasis on utilization management. * Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
Ensures contract outcome measures are met with emphasis on utilization management. * Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
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Ensures contract outcome measures are met with emphasis on utilization management. * Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
Pompano Beach, FL · Remote
$45K - $65K/hr
Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Establish and maintain contracts with managed care companies and request rate increases when ...
Pompano Beach, FL · Remote
$45K - $65K/hr
Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Establish and maintain contracts with managed care companies and request rate increases when ...
Ensures contract outcome measures are met with emphasis on utilization management. * Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
Ensures contract outcome measures are met with emphasis on utilization management. * Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
Fort Myers, FL · On-site
$42/hr
Slate Healthcare is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Fort Myers, FL · On-site
$42/hr
Slate Healthcare is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically ... Coordination and review of all subacute and SNF admissions with the Interdisciplinary Team driving ...
Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically ... Coordination and review of all subacute and SNF admissions with the Interdisciplinary Team driving ...
... review activities; discharge care coordination for determining efficiency, effectiveness and ... contract guidelines. Provides information regarding utilization management requirements and ...
... review activities; discharge care coordination for determining efficiency, effectiveness and ... contract guidelines. Provides information regarding utilization management requirements and ...
We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement. THE OPPORTUNITY: We are currently seeking Board-Certified physicians in RADIOLOGY to conduct ...
We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement. THE OPPORTUNITY: We are currently seeking Board-Certified physicians in RADIOLOGY to conduct ...
Chicago, IL · On-site
Chicago, IL Contract * Participates in the development and ongoing implementation of QM Work Plan ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...
Chicago, IL · On-site
Chicago, IL Contract * Participates in the development and ongoing implementation of QM Work Plan ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...
Atlanta, GA · On-site
$3.0K - $3.1K/wk
Utilization Review Shift: 09:30 AM to 08:00 PM 13 weeks contract Description: * Utilization Review RN - Target Review * Health Plan Insurance (no acute care) * BLS (AHA) * RN state license Company ...
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Atlanta, GA · On-site
$3.0K - $3.1K/wk
Utilization Review Shift: 09:30 AM to 08:00 PM 13 weeks contract Description: * Utilization Review RN - Target Review * Health Plan Insurance (no acute care) * BLS (AHA) * RN state license Company ...
Plano, TX · Remote
Determines benefit levels in accordance to contract guidelines. * Provides information regarding ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...
Plano, TX · Remote
Determines benefit levels in accordance to contract guidelines. * Provides information regarding ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...
Dallas, TX · Remote
$40/hr
... review activities; discharge care coordination for determining efficiency, effectiveness and ... contract guidelines. Provides information regarding utilization management requirements and ...
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Dallas, TX · Remote
$40/hr
... review activities; discharge care coordination for determining efficiency, effectiveness and ... contract guidelines. Provides information regarding utilization management requirements and ...
Portales, NM · On-site
Job Title: RN Utilization Review City: Portales State: NM Job Type: Travel Discipline: RN ... Yes Contract Length: 13 weeks Shifts: Days Shift Details: Day 5x8-Hour Weekly Schedule: 40 Hours ...
Portales, NM · On-site
Job Title: RN Utilization Review City: Portales State: NM Job Type: Travel Discipline: RN ... Yes Contract Length: 13 weeks Shifts: Days Shift Details: Day 5x8-Hour Weekly Schedule: 40 Hours ...
Cleveland, OH · On-site
$2.2K/wk
... Utilization Review Job ID 18807560 Job Title RN - Utilization Review Weekly Pay $2214.0 Shift ... Middleburg Heights, Ohio Shift: 8 Hour Flex, 07:00:00-15:00:00 Contract Length: 12.71 weeks Start ...
Cleveland, OH · On-site
$2.2K/wk
... Utilization Review Job ID 18807560 Job Title RN - Utilization Review Weekly Pay $2214.0 Shift ... Middleburg Heights, Ohio Shift: 8 Hour Flex, 07:00:00-15:00:00 Contract Length: 12.71 weeks Start ...
Troy, MI · On-site +1
$150/hr
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM ...
New
Troy, MI · On-site +1
$150/hr
The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM ...
New
Tuba City, AZ · On-site
$2.6K/wk
RN,AZ - Utilization Review RN, City: Tuba City, State: Arizona, Estimated Start Date:09/07/2026 ... Contract (Days) : 91, Estimated Gross Pay: 0.00 Convergence Medical Staffing is known for ...
Tuba City, AZ · On-site
$2.6K/wk
RN,AZ - Utilization Review RN, City: Tuba City, State: Arizona, Estimated Start Date:09/07/2026 ... Contract (Days) : 91, Estimated Gross Pay: 0.00 Convergence Medical Staffing is known for ...
Torrance, CA · On-site
$1.8K - $1.9K/wk
Travel/Contract Pay: $1816 - $1912 per week Shift: 5x8 Days Start Date: ASAP Contract Length: 13-week Position: RN Utilization Review (Travel/Contract) We're hiring experienced RN Utilization Review ...
New
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Torrance, CA · On-site
$1.8K - $1.9K/wk
Travel/Contract Pay: $1816 - $1912 per week Shift: 5x8 Days Start Date: ASAP Contract Length: 13-week Position: RN Utilization Review (Travel/Contract) We're hiring experienced RN Utilization Review ...
New
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.
A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.
To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.
Cities with the most Contract Utilization Review job openings:
The most popular types of Utilization Review jobs are:
States with the most job openings for Contract Utilization Review jobs include:
The top searched job categories for Contract Utilization Review jobs are:
Canton, MA • On-site
$55 - $60/hr
Other
Posted 20 days ago
$55-$60 per hour
Canton, MA
Contract
Duration: 6 Month Contract (Possibility of Extension)
Position Overview
We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review.
This role is responsible for reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare providers, and ensuring timely authorization decisions while maintaining compliance with regulatory standards.
Key Responsibilities
Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests.
Review clinical documentation and determine benefit eligibility using evidence-based clinical guidelines and health plan policies.
Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services.
Ensure all utilization review activities meet regulatory turnaround time requirements.
Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.
Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare facilities.
Participate in appeal reviews and provide clinical recommendations when appropriate.
Maintain accurate documentation within utilization management systems.
Monitor cases for quality, compliance, and adherence to organizational policies.
Identify opportunities for process improvement and contribute to quality initiatives.
Serve as a clinical resource for internal teams regarding utilization management guidelines and medical necessity criteria.
Required Qualifications
Active, unrestricted Registered Nurse (RN) license.
Associate Degree in Nursing (ADN) required.
Minimum 5 years of RN clinical experience.
Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical Management experience.
Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.
Strong knowledge of:
Utilization Management (UM)
Medical Necessity Review
Prior Authorization
Precertification
InterQual and/or MCG Guidelines
Experience reviewing outpatient clinical services.
Excellent clinical assessment and critical thinking skills.
Strong communication skills with providers and interdisciplinary teams.
Ability to work independently in a remote environment.
Comfortable using multiple systems while managing a high-volume workload.
Preferred Qualifications
BSN preferred.
Experience with outpatient utilization management.
Experience using InterQual and/or MCG clinical criteria.
Experience with Medicare Advantage or Commercial Health Plans.
Previous experience with appeals, grievances, or denial reviews.
Knowledge of NCQA, CMS, and utilization management regulatory requirements.
Note:
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
