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Utilization Review 1099 Jobs in Nebraska (NOW HIRING)

CHI Health

Utilization Review RN

Omaha, NE · On-site

$33.51 - $48.58/hr

Job Summary and Responsibilities As our Utilization Review RN, you will play a pivotal role in optimizing healthcare delivery by ensuring medical necessity and appropriate patient status throughout ...

Dane Street

Orthopedics Physician

Minatare, NE · 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 ...

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Utilization Review 1099 information

What is a utilization review 1099?

A Utilization Review 1099 position refers to a healthcare professional, often a nurse or therapist, who works as an independent contractor (not a direct employee) to review medical cases for necessity and efficiency. The '1099' designation means they receive a Form 1099 for tax purposes and are responsible for their own taxes. Utilization Review specialists evaluate patient records to ensure treatments are appropriate and meet insurance or regulatory guidelines. These roles are often remote and offer flexible hours, but do not provide traditional employee benefits.

What are the key skills and qualifications needed to thrive as a utilization review 1099?

To thrive as a Utilization Review 1099 professional, you need a strong clinical background (often as a registered nurse or similar), experience with medical necessity criteria, and familiarity with insurance guidelines. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory requirements are typically required, along with URAC or CCM certification being advantageous. Excellent analytical thinking, attention to detail, and effective communication skills are essential for collaborating with healthcare providers and payers. These skills ensure accurate, efficient review of patient care for coverage decisions, compliance, and cost-effective healthcare delivery.

What are some typical challenges faced by utilization review 1099 contractors, and how can they be managed?

Utilization Review professionals working as 1099 contractors often face challenges such as fluctuating caseloads, varying client requirements, and the need to stay current with changing regulations independently. Unlike full-time employees, contractors must also manage their own schedules, billing, and sometimes provide their own resources and training. To succeed, it's important to establish clear communication with clients, maintain up-to-date credentials, and leverage professional networks or continuing education resources to stay informed about industry changes.

What is the difference between Utilization Review 1099 vs Utilization Review Nurse?

AspectUtilization Review 1099Utilization Review Nurse
CredentialsVaries; often self-employed or independent contractorsRegistered Nurse (RN) license required
Work EnvironmentRemote or freelance; contract basisHealthcare facilities, insurance companies, or clinics
Employer/Industry UsageFreelance or independent consulting in healthcareHospitals, insurance providers, healthcare organizations
Work FocusReviewing medical necessity for insurance claimsAssessing patient records, making clinical decisions

Utilization Review 1099 typically refers to independent contractors reviewing insurance claims, often working remotely. Utilization Review Nurse is a licensed RN performing clinical assessments within healthcare settings. While both roles involve utilization review, the 1099 role emphasizes independent contracting, whereas the nurse role requires clinical credentials and direct patient or clinical record involvement.

What are popular job titles related to Utilization Review 1099 jobs in Nebraska?

For Utilization Review 1099 jobs in Nebraska, the most frequently searched job titles are:

What job categories do people searching Utilization Review 1099 jobs in Nebraska look for?

The top searched job categories for Utilization Review 1099 jobs in Nebraska are:

What cities in Nebraska are hiring for Utilization Review 1099 jobs?

Cities in Nebraska with the most Utilization Review 1099 job openings:

Utilization Review 1099 jobs near you
Infographic showing various Utilization Review 1099 job openings in Nebraska as of August 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 71% In-person, and 29% Remote job distribution.

Utilization Review Specialist

Berkshire Hathaway Homestate Companies

Omaha, NE • On-site

Full-time

Re-posted 5 days ago

Job description

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening for a Utilization Review Specialist in Omaha to join its Medical Management team.  The individual ensures that medical treatment requests from providers are medically appropriate and reviewed in compliance with State laws and Company policies. 
ESSENTIAL RESPONSIBILITIES
  • Triages and manages intake coordination of requests for authorization and independent medical review requests. 
  • Reviews authorization requests for approval in accordance with evidence-based medical treatment guidelines. 
  • Researches claim files in relation to the requested medical treatment, interprets medical reports while utilizing critical thinking, and applies appropriate established guidelines to requested treatment. 
  • Advocates for the injured worker and Claims department, ensuring proposed treatment requests are appropriate for the diagnosis. 
  • Escalates treatment requests outside of authorization authority for review by a Utilization Review Specialist 2 or Utilization Review Nurse. 
  • Ensures that utilization review processes are performed in accordance with the time limits and other requirements set by State law and Company policy. 
  • Routinely contacts providers to clarify treatment requests and examination findings, as well as to obtain additional medical information as needed. 
  • Gains and Maintains a thorough understanding of Company policies regarding the review of authorization requests by Utilization Review Specialists. 
  • Establishes and maintains a close, positive communicative relationship and working partnership with Medical Bill Review staff to ensure effective and efficient integrated medical management of treatment provided to injured workers.
  • Fosters a positive and close working relationship with other Company staff, including adjusting staff, other Medical Management staff, Special Investigations Unit, Legal, Liens, Customer Care, and Client Services.
  • Maintains patient confidentiality and safeguards protected health information in accordance with State and Federal laws and Company policies. 
  • Enters clear, concise, and accurate documentation of requested medical treatments, to include clinical findings, treatment guidelines, and determinations. 
  • Ensures that appropriate notices are forwarded to medical providers, injured workers, Claims staff, and attorneys. 
  • Provides general office or administrative support throughout the department.  
QUALIFICATIONS
  • EDUCATION: Bachelor's or Associate's degree in a medical field from an accredited college or technical school required. 
  • EXPERIENCE: Minimum of 6 months of relevant experience and/or training in a medical field, or equivalent combination of education and experience, required. 
  • TECHNICAL SKILLS: Able to effectively use Microsoft Office/365 applications and able to become proficient in proprietary and vendor software applications. 
  • LANGUAGE ABILITY: Able to read and understand basic documents, including statutes, regulations, medical records, medical bills, medical resource materials, claim notes, and claim data fields. Able to write clear, concise reports accurately conveying complex and nuanced information, as well as correspondence on medical and legal points. Able to effectively present information and respond to questions with adjusting staff, Management, and others. 
  • MATH AND REASONING ABILITY: Able to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Able to interpret a variety of instructions furnished in written, oral, diagram, graph, or schedule form. Able to apply concepts such as addition, subtraction, multiplication, division, fractions, percentages, ratios, and proportions to practical situations. Ability to derive appropriate conclusions and apply on the job.
 
CORE COMPETENCIES
ATTENTION TO DETAIL 
   Double-checks the accuracy of information and work product to provide accurate and consistent work.
   Completes all work according to procedures and standards.
   Works in a conscientious, consistent, and thorough manner.
COMMUNICATION 
   Communicates and articulates clearly; is informative and appropriately concise.
   Asks questions freely to broaden knowledge and skills.
   Prepares clear and concise e-mails and other basic required written communications.
PROBLEM SOLVING & DECISION MAKING 
   Is objective; is able to evaluate facts apart from personal bias.
   Identifies key decisions within area of responsibility and escalates tasks to appropriate authority as needed.
   Effectively uses appropriate decision-making techniques.
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