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Contract Utilization Review Jobs in Rome, NY (NOW HIRING)

Lthc

Medical Director, Commercial

Utica, NY · On-site

Utilization review activities include: reviews of requests for broad range of medical services ... Makes accurate and consistent interpretation of integral medical policy, contract benefits and ...

Lthc

Medical Director, Commercial

Utica, NY · On-site

Utilization review activities include: reviews of requests for broad range of medical services ... Makes accurate and consistent interpretation of integral medical policy, contract benefits and ...

Lthc

Medical Director, Commercial

Utica, NY

Utilization review activities include: reviews of requests for broad range of medical services ... Makes accurate and consistent interpretation of integral medical policy, contract benefits and ...

Lthc

Utilization Management Services Rep I

Utica, NY

$16.25 - $22.25/hr

... review and creation of desk level procedures, acting as a subject matter expert for UM Services ... contract benefits. * Advanced skills working between multiple programs and applications ...

Lthc

Utilization Management Services Rep I

Utica, NY · On-site

$16.25 - $22.25/hr

... review and creation of desk level procedures, acting as a subject matter expert for UM Services ... contract benefits. * Advanced skills working between multiple programs and applications ...

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Contract Utilization Review information

See Rome, NY salary details

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How much do contract utilization review jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for contract utilization review in Rome, NY is $40.03, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $45.96 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Contract Utilization Review position, and why are they important?

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 typical day look like for someone working in Contract Utilization Review?

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 job?

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 popular job titles related to Contract Utilization Review jobs in Rome, NY? For Contract Utilization Review jobs in Rome, NY, the most frequently searched job titles are:
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Contract Utilization Review jobs near you

RN - Utilization Review - Syracuse, NY - RN26-06292

NavitasPartners

Rome, NY • On-site

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Job Title: RN - Utilization Review
Location: Syracuse, NY
Type: Contract | 14 Weeks
Shift & Schedule: Day Shift | Full-Time | Monday-Friday

Position Overview:
Navitas Healthcare, LLC is seeking RN - Utilization Review for an exciting Travel or Local job in Syracuse, NY.

Responsibilities

  • Conduct utilization review activities for inpatient admissions and continued stays
  • Review medical records to determine medical necessity and appropriate level of care using established screening criteria
  • Ensure compliance with CMS regulations, payer requirements, and hospital policies
  • Collaborate with physicians, case managers, nursing staff, and payers regarding authorization and care coordination
  • Interface with healthcare payers and regulatory agencies regarding patient status and reimbursement requirements
  • Monitor admission status, discharge planning, and length of stay management
  • Maintain accurate and timely documentation within the electronic medical record system
  • Participate in quality improvement and performance initiatives related to utilization management
  • Identify and escalate cases requiring physician advisor review or additional clinical documentation
  • Support denial prevention and appeal processes when necessary

Requirements

  • Current New York State RN License required
  • Current BLS Certification required
  • Minimum 1.5 years of recent acute care hospital experience within the last 2 years required
  • Strong clinical assessment, critical thinking, and analytical skills
  • Excellent verbal and written communication skills
  • Ability to work independently and collaboratively in a fast-paced healthcare environment

Preferred Qualifications

  • Utilization Review, Utilization Management, or Case Management experience preferred
  • Experience with MCG or InterQual screening tools preferred
  • Knowledge of CMS regulations related to hospital admissions and utilization review preferred
  • Experience interfacing with healthcare payers and regulatory agencies preferred
  • EPIC EMR experience preferred
  • Experience with payer authorization processes and denial management preferred
  • Trauma center or large hospital experience preferred

For more details contact at hdavda@navitashealth.com or Call / Text at 516-862-1169.

About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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