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Contract Utilization Review Nurse Jobs (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Determines benefit levels in accordance to contract guidelines. * Provides information regarding ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...

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 ...

McBee Associates

Utilization Review Nurse

Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required * Current and unrestricted RN license * At least 3 years ...

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 ...

Netsmart

Utilization Review Nurse

Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required * Current and unrestricted RN license * At least 3 years ...

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 ...

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 ...

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How much do contract utilization review nurse jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for contract utilization review nurse 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 is a contract utilization review nurse?

A Contract Utilization Review Nurse is a registered nurse who works on a contractual basis to review medical records and health care services for appropriateness, necessity, and efficiency. Their primary role is to ensure that patients receive the right care while helping healthcare organizations comply with regulations and control costs. These nurses often work for insurance companies, hospitals, or third-party review organizations, and they assess requests for medical procedures, hospital admissions, and ongoing treatments. They use established guidelines and clinical criteria to make determinations and frequently interact with healthcare providers to gather additional information. Contract positions may offer flexibility and the opportunity to work remotely.

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

To thrive as a Contract Utilization Review Nurse, you need a current RN license, strong clinical knowledge, and experience in medical record review and case management. Familiarity with utilization management software, InterQual or MCG guidelines, and health insurance regulations is typically required. Excellent analytical thinking, attention to detail, and effective communication skills help in collaborating with providers and ensuring compliance. These abilities are essential for delivering accurate utilization reviews, optimizing patient outcomes, and supporting cost-effective healthcare operations.

What are some common challenges faced by contract utilization review nurses, and how can they be addressed?

Contract Utilization Review Nurses often face the challenge of managing high caseloads while maintaining accuracy and timeliness in their reviews. Working remotely or across multiple facilities can require strong organizational skills and effective communication with interdisciplinary teams. Adapting quickly to different payer guidelines and documentation systems is also essential. Staying current with changes in healthcare regulations and leveraging technology can help overcome these challenges, ensuring both compliance and quality patient care.

What is the difference between Contract Utilization Review Nurse vs Utilization Review Nurse?

AspectContract Utilization Review NurseUtilization Review Nurse
CredentialsRN license, certification in case management or utilization review often preferredRN license, certification in case management or utilization review often preferred
Work EnvironmentTypically contracted for specific projects or timeframes, often remote or in healthcare facilitiesUsually employed full-time by healthcare organizations, hospitals, or insurance companies
Employer & Industry UsageContract agencies, healthcare facilities, insurance companiesHospitals, insurance companies, healthcare organizations

The main difference is that Contract Utilization Review Nurses work on a temporary, contract basis, often through agencies, while Utilization Review Nurses are usually employed full-time by healthcare or insurance organizations. Both roles require similar credentials and focus on reviewing medical necessity and appropriateness of care.

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Contract Utilization Review Nurse jobs near you
Infographic showing various Contract Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Bracane Co

Plano, TX • Remote

Full-time

Re-posted 8 days ago

Job description

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***

JOB DESCRIPTION:

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

JOB RESPONSIBILITIES:

  • This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.
  • Collects clinical and non-clinical data.
  • Verifies eligibility.
  • Determines benefit levels in accordance to contract guidelines.
  • Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.

JOB QUALIFICATIONS (Required):

  • Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.

JOB QUALIFICATIONS (Preferred):

  • MCG or InterQual experience
  • Utilization management experience

LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin Counties).

POSITION: 6-month assignment

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