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Contract Utilization Review Jobs in Reno, NV (NOW HIRING)

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 ...

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 ...

Renown Health

Pharmacy Regulatory Analyst

Reno, NV · On-site

... of all contract pharmacies. Documents results and follow-up on any findings. • Reviews and ... Clearly documents utilization, savings, problem areas, and exceptions or discrepancies. Relays ...

Renown Health

Pharmacy Regulatory Analyst

Reno, NV · On-site

$28.29 - $39.63/hr

... of all contract pharmacies. Documents results and follow-up on any findings. • Reviews and ... Clearly documents utilization, savings, problem areas, and exceptions or discrepancies. Relays ...

Renown Health

Pharmacy Regulatory Analyst

Reno, NV · On-site

... of all contract pharmacies. Documents results and follow-up on any findings. • Reviews and ... Clearly documents utilization, savings, problem areas, and exceptions or discrepancies. Relays ...

Sundt

Project Executive - Data Center

Reno, NV · On-site

This transition shall include project review meetings, which encompass a review of contract ... utilization, constructability, formwork, materials, manpower, general conditions, schedule ...

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How much do contract utilization review jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for contract utilization review in Reno, NV is $42.16, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.41 per hour, depending on experience, location, and employer.

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 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 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.

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The most popular types of Utilization Review jobs in Reno, NV are:

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Contract Utilization Review jobs near you

DIRECTOR OF VALUE BASED CARE AND POPULATION HEALTH

Carson City, NV • On-site

Carson Tahoe Health
See more jobs at Carson Tahoe Healthexternal

Full-time

Re-posted 20 hours ago

Carson Tahoe Health rating

7.9

Company rating: 7.9 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

US:NV:Carson City Population Health
Full Time Day Shift
Summary
The Director of Value-Based Care & Population Health is responsible for leading Carson Tahoe Health's population health, care coordination, utilization reduction, and value-based care initiatives in support of organizational quality, clinical performance, and financial sustainability goals.
The Director collaborates with physician leaders, case management, utilization review, quality, finance, medical group operations, and executive leadership to improve outcomes under value-based reimbursement models, including Medicare Advantage and risk-based contracts.
This position provides operational leadership for initiatives focused on reducing avoidable utilization, improving care transitions, closing care gaps, supporting risk adjustment efforts, improving patient outcomes, and advancing organizational population health strategies
Qualifications
Required:
  • Bachelor's degree in Healthcare Administration, Business, or related field or equivalent combination of education and experience
  • Ten (10) years experience in population health, risk-based reimbursement experience, value-based care operational leadership experience, care management and utilization management experience or related;
  • Five (5) years progressively responsible experience as program lead, team lead or management
  • Knowledgeable in the areas of health care delivery systems, social determinants of health and health care transformation, and have an understanding of relevant Federal and State regulatory requirements

Preferred:
  • Master's degree in Nursing, Healthcare Administration or related field

Essential Functions
  • Lead operational execution of Carson Tahoe Health's population health and value-based care strategies.
  • Collaborate with Case Management, Utilization Review, Quality, Medical Group Operations, and physician leadership to improve performance under value-based reimbursement arrangements.
  • Support organizational initiatives focused on reducing avoidable admissions, readmissions, emergency department utilization, and total cost of care.
  • Develop and implement programs targeting high-risk and rising-risk patient populations.
  • Monitor population health performance metrics and recommend operational improvements based on organizational data and performance trends.
  • Support care gap closure initiatives and collaborate with ambulatory operations and providers to improve preventive care and chronic disease management outcomes.
  • Partner with Finance and Payer Relations to monitor value-based contract performance and identify opportunities for improvement.
  • Collaborate with Medical Group Operations to support attribution strategies, patient retention efforts, and access initiatives.
  • Support RAF/HCC documentation improvement initiatives in collaboration with physician leadership and ambulatory operations.
  • Facilitate multidisciplinary value-based care workgroups and performance improvement initiatives.
  • Prepare executive-level reports and dashboards related to population health, utilization management, care coordination, and value-based care performance.
  • Monitor emerging trends in population health, Medicare Advantage, value-based reimbursement, and care management practices
  • Perform other duties as assigned.
    • Primary Areas of Accountability:
      • Population Health Strategy
      • Value-Based Care Operations
      • High-Risk Patient Management
      • Care Gap Closure
      • Readmissions Reduction
      • Avoidable Utilization Reduction
      • Care Coordination Initiatives
      • Risk Adjustment Support
      • Medicare Advantage Performance
      • Population Health Analytics
      • Value-Based Care Governance Coordination

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