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Contract Utilization Review Jobs in Spring Valley, NY

Hudson Regional Hospital

RN Case Manager

Secaucus, NJ · On-site

$90K - $100K/yr

... contract in order to certify the patients' stays. Contacts the Attending Physician to obtain ... Knowledge of Utilization Review criteria to include Interqual and/or Milliman preferred.

ATD Technology LLC

Care Manager - ED

Bronx, NY · On-site

$58 - $60/hr

Utilization review and discharge planning Computer literacy. * Leadership experience. - preferred ... ATD is a full service provider with offerings in Contract, Permanent and Temp-to-Perm staffing ...

LanceSoft

Travel Nurse RN - Case Management

Bronx, NY · On-site

Utilization Review (UR) is a separate dept- UR will do insurance approvals and arranging ... Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to ...

Medix

Registered Nurse

New York, NY · Remote

$48 - $55/hr

Support utilization review, prior authorization reviews, appeals, and clinical documentation ... Indefinite contract opportunity Equipment Policy Company-issued equipment will be provided. To ...

Acacia Network

Program Director

Bronx, NY · On-site

$85K/yr

Perform utilization reviews, monitoring case records, ensuring compliance with all contract stipulations. * Review OASAS Website keeping updated with 820 regulations and local service bulletins.

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Showing results 21-40

All JobsContract Utilization Review JobsContract Utilization Review Jobs in Spring Valley, NY

Contract Utilization Review information

See Spring Valley, NY salary details

$21

$42

$69

How much do contract utilization review jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for contract utilization review in Spring Valley, NY is $42.85, according to ZipRecruiter salary data. Most workers in this role earn between $33.85 and $49.18 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 cities near Spring Valley, NY are hiring for Contract Utilization Review jobs? Cities near Spring Valley, NY with the most Contract Utilization Review job openings:
Contract Utilization Review jobs near you
Infographic showing various Contract Utilization Review job openings in Spring Valley, NY as of June 2026, with employment types broken down into 2% As Needed, 29% Full Time, 40% Part Time, 2% Temporary, and 27% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $89,118 per year, or $42.8 per hour.

RN Case Manager

Hudson Regional Hospital

Secaucus, NJ • On-site

$90K - $100K/yr

Full-time

Re-posted 3 days ago

Hudson Regional Hospital rating

7.2

Company rating: 7.2 out of 10

Based on 12 frontline employees who took The Breakroom Quiz

428th of 1,058 rated hospitals

Job description

Position Summary

Provides case management as well as routine discharge planning services to patients and their families, to facilitate safe and timely discharges, to enhance the benefits of medical care, to ensure hospital reimbursement, to provide cost effective acute care and to ensure continuity of care.

Job Duties

  • Reviews all patient charts within 24 to 48 hours of admission to assess appropriateness of admission, intensity of service and potential discharge needs in accordance with the utilization/contractual requirements.
  • All questionable cases (i.e. inappropriate admission, level of care changes, quality issues) will be communicated to the Attending Physician. If no resolution, CM will refer the cases to the Physician Advisor.
  • Communicates with insurance providers for admission and continued stay reviews as stipulated by contract in order to certify the patients' stays. Contacts the Attending Physician to obtain additional clinical information on the case to minimize denials and to assist with reimbursement of care and/or appeals.
  • Denied day cases will automatically be referred to the Physician Advisor.
  • Participants in Interdisciplinary D/C Rounds to concurrently and collaboratively review and facilitate the patient's plan of care. Acts as liaison to assist in identifying opportunities to improve care.
  • Keeps Director of Case Management abreast of problem areas and seeks guidance in a timely manner.
  • Effectively coordinates care with ancillary departments and attending physician (i.e. rehabilitation, laboratory, radiology, etc.) to ensure timely provision of care and to decrease length of stay and appropriate treatment and discharge.
  • Performs other job duties and responsibilities as assigned.

Qualifications and Skills

  • Knowledge of Utilization Review criteria to include Interqual and/or Milliman preferred.
  • Knowledge in Medicaid, Medicare, Managed Care review and documentation requirements. Is knowledgeable of state and federal regulations, DNV standards and practices for acute care facilities.
  • Excellent written and verbal communication skills.
  • Knowledge in discharge planning and length of stay initiatives.
  • Knowledge of home care and referral process.
  • Expert critical thinking and problem solving skills.

Education, Experience and Certification/Licensure Requirements

  • Current RN license in the state of NJ.
  • Minimum 1- 2 years direct patient care experience in an acute care hospital
  • Previous case management experience preferred.


What Hudson Regional Hospital employees say

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About Hudson Regional Hospital

Sourced by ZipRecruiter

Hudson Regional Hospital is the Premier Hospital providing Comprehensive Care to Northern New Jersey. Our mission is to build a Healthier Community through Exceptional care, Sophisticated Technology, and Knowledgeable Physicians. We are excited for the future of Hudson Regional Hospital as we continue to integrate new ideas and build on improvements across our facility.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Secaucus, NJ, US

Year founded

2018

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