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Contract Utilization Review Jobs (NOW HIRING)

Uoflhealth

RN Utilization Review

Louisville, KY · On-site

The Utilization Review RN performs activities which support the Utilization Management functions ... and contracts, philosophy, mission and values of UofL Health, assumes responsibility and ...

UofL Health

RN Utilization Review

Louisville, KY · On-site

The Utilization Review RN performs activities which support the Utilization Management functions ... and contracts, philosophy, mission and values of UofL Health, assumes responsibility and ...

HCS 247

Travel Utilization Review Nurse

Kinston, NC · On-site

Utilization Review * Discipline: RN * Start Date: 07/06/2026 * Duration: 13 weeks * 40 hours per ... This will be a Local Contract and will offer the most competitive rates in the industry.

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Contract Utilization Review information

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How much do contract utilization review jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for contract utilization review 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 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.

More about Contract Utilization Review jobs
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What are the most commonly searched types of Utilization Review jobs? The most popular types of Utilization Review jobs are:
What states have the most Contract Utilization Review jobs? States with the most job openings for Contract Utilization Review jobs include:
What job categories do people searching Contract Utilization Review jobs look for? The top searched job categories for Contract Utilization Review jobs are:
Contract Utilization Review jobs near you
RN - Utilization Review (Remote)

RN - Utilization Review (Remote)

Amergis Healthcare Staffing

Baltimore, MD

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 5 days ago

Key responsibilities

  • Performs utilization review in accordance with all state mandated regulations.

  • Reviews patient records and evaluates patient progress to ensure appropriate and cost-effective healthcare services.

  • Analyzes insurance, governmental, and accrediting standards to determine criteria concerning admissions, treatment, and length of stay.

Job description

"

The Utilization Review Specialist is responsible for the assessment and review of the healthcare delivery system with a concentration on tasks that promote cost-effective quality care and cost containment in accordance with various federal and/or state statutes, regulations and guidelines as well as facility policy.

Essential Duties and Responsibilities:

  • Performs utilization review in accordance with all state mandated regulations
  • Analyzes insurance, governmental and accrediting standards to determine criteria concerning admissions, treatment, and length of stay
  • Assures compliance with state and federal regulations and billing requirements
  • Maintains compliance with regulation changes affecting utilization management
  • Reviews patient records and evaluates patient progress
  • Ensures high standard of patient care by establishing best practice benchmarks
  • Obtains and reviews necessary medical reports and related treatment plan to conduct review
  • Reviews and validates physician’s orders, reports progress, and unusual occurrences on patients
  • Ensures appropriate and cost-effective healthcare services to patients.
  • Analyzes patient records and participates in interdisciplinary collaboration with professional staff
  • Facilitates educational programs as directed to keep physicians and professional staff informed about regulations affecting utilization management
  • Recognizes and reports appropriately cases of fraud, abuse or incorrect utilization
  • Consults with Social Services Department regarding the level of nursing care and collaborates with other departments in evaluation of projects affecting discharge plans
  • Supports performance improvement programs
  • Performs continuing review on medical records and identifies and evaluates need of ongoing hospitalization and services

Minimum Requirements:

  • Current license for the state in which the nurse practices if nursing licensure is required by contract
  • A Bachelor’s Degree in Nursing or at least two years’ experience in Utilization Review preferred
  • Certification in Utilization Review or Utilization Management preferred
  • Experience with Microsoft Office Suite and the ability to learn new information systems and software programs
  • Strong problem solving, project management and organizational skills with an ability to work in a fast paced environment
  • General knowledge of managed care delivery system
  • Complies with all relevant professional standards of practice 
  • Participation and completion of Amergis' Competency program when applicable
  • Current CPR if applicable
  • TB questionnaire, PPD or chest x-ray if applicable 
  • Current Health certificate (per contract or state regulation) 
  • Must meet all federal, state and local requirements 
  • Successful completion of new hire training as applicable to job site 
  • Understand patient confidentiality and HIPAA requirements  
  • Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language is required  
  • Computer proficiency required 
  • Must be at least 18 years of age 
"
Benefits
At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
  • Competitive pay & weekly paychecks
  • Health, dental, vision, and life insurance
  • 401(k) savings plan
  • Awards and recognition programs 
*Benefit eligibility is dependent on employment status. 

About Amergis
Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.  

Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

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