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Contract Utilization Review Jobs in Nevada (NOW HIRING)

Dane Street

Orthopedics Physician

Reno, NV

Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street

Board-Certified Orthopedic Surgeon

Reno, NV · On-site

Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street

Orthopedics Physician

Reno, NV · On-site

Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street

Board Certified Orthopedic Surgeon

Reno, NV · On-site

Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

UHS

Manager - Payer Strategies - Acute

Las Vegas, NV

$85K - $114K/yr

Provides ongoing analysis and reporting on existing contracts for compliance, performance reviews, net revenue budgeting, long-range planning, and survey responses. Studies historical utilization and ...

UHS

Manager - Payer Strategies - Acute

Las Vegas, NV · On-site

$85K - $114K/yr

Provides ongoing analysis and reporting on existing contracts for compliance, performance reviews, net revenue budgeting, long-range planning, and survey responses. Studies historical utilization and ...

UHS

Manager - Payer Strategies - Acute

Las Vegas, NV · On-site

$95K - $135K/yr

Provides ongoing analysis and reporting on existing contracts for compliance, performance reviews, net revenue budgeting, long-range planning, and survey responses. Studies historical utilization and ...

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Contract Utilization Review information

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$43

$70

How much do contract utilization review jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for contract utilization review in Nevada is $43.06, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.42 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in contract utilization review?

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.

What does a contract utilization review do?

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.

What is a contract utilization review?

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.

What are the most commonly searched types of Utilization Review jobs in Nevada? The most popular types of Utilization Review jobs in Nevada are:
What are popular job titles related to Contract Utilization Review jobs in Nevada? For Contract Utilization Review jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Contract Utilization Review jobs in Nevada look for? The top searched job categories for Contract Utilization Review jobs in Nevada are:
What cities in Nevada are hiring for Contract Utilization Review jobs? Cities in Nevada with the most Contract Utilization Review job openings:
Contract Utilization Review jobs near you
Infographic showing various Contract Utilization Review job openings in Nevada as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $89,556 per year, or $43.1 per hour.

Medical Director, Utilization Management (Commercial & MA)

HJ Staffing

Henderson, NV • Remote

Full-time

Medical

Posted 17 days ago

Job description

We are seeking a Medical Director of Utilization Management to lead and support the clinical integrity of our utilization management (UM) functions, with a primary focus on inpatient and post-acute care reviews.

In this role, you will ensure timely, consistent, and appropriate care determinations for Commercial and Medicare Advantage members. By leveraging evidence-based practices, CMS regulations, and health plan benefit structures, you will evaluate the medical necessity of care, participate in peer-to-peer consultations, and collaborate with multidisciplinary teams to drive optimal clinical outcomes, regulatory compliance, and cost efficiency.

Duration: August 10, 2026 - February 10, 2027

Location: Henderson, NV (100% Fully Remote Opportunity)

Reporting To: Chief Medical Officer

Start Date: Immediate Need

Key Responsibilities
  • Utilization Review & Medical Necessity: Conduct timely medical necessity determinations for inpatient admissions, continued stays, and post-acute care settings (SNF, IRF, LTACH, Home Health) for Commercial and Medicare Advantage populations.
  • Evidence-Based Evaluation: Apply nationally recognized guidelines (MCG, InterQual), CMS coverage criteria, and health plan policies to ensure appropriate level-of-care determinations.
  • Complex Case Escalation: Serve as the lead physician reviewer for complex, high-risk, or potentially adverse UM cases requiring clinical judgment.
  • Peer-to-Peer Engagement: Conduct peer-to-peer discussions with attending and treating physicians to clarify documentation, discuss options, and align on appropriate care plans.
  • Cross-Functional Collaboration: Partner with Care Management and UM teams to identify utilization trends, reduce avoidable readmissions/extended stays, and streamline care transitions.
  • Policy & Quality Support: Offer clinical expertise to support quality improvement initiatives, regulatory audit preparedness (CMS/NCQA), policy development, and UM committee activities.
  • Documentation & Compliance: Maintain precise, compliant, and timely documentation of all reviews and rationales in accordance with federal, state, and organizational guidelines.
Must-Have Qualifications
  • Education & Licensure: Active M.D. or D.O. degree with an active, unrestricted medical license in good standing (in state of residence).
  • Board Certification: Current Board Certification in an appropriate medical specialty.
  • Clinical & Leadership Experience: Minimum of 5 years of clinical practice, including at least 3 years of direct experience in utilization management, physician review, or medical leadership within a managed care or health plan setting.
  • Population Expertise: Demonstrated physician-level experience supporting Commercial and/or Medicare Advantage lines of business.
What Will Make You Successful
  • Criteria Proficiency: Advanced expertise with MCG guidelines and strong working knowledge of InterQual and CMS criteria.
  • Regulatory Knowledge: Deep understanding of Medicare Advantage regulations, Commercial health plan benefit structures, and state/federal UM mandates.
  • Technical Skills: Experience navigating medical management platforms, enterprise applications, and Microsoft Office products.
  • Communication & Negotiation: Exceptional written and oral communication skills, with a proven ability to handle delicate peer-to-peer discussions and articulate complex clinical rationales clearly.
  • Analytical Mindset: Strong problem-solving abilities, attention to detail, and a data-driven approach to identifying utilization trends and quality gaps.
Preferred Qualifications
  • Master's degree in Public Health, Business Administration, or Health Administration (MPH, MBA, or MHA).
  • Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
Why Apply?

This is a 100% remote, high-impact contract opportunity starting immediately, offering you the flexibility of working from home while managing key clinical determinations for a dynamic health plan environment.

Employment Type: FULL_TIME

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