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Utilization Review 1099 Jobs in Nebraska (NOW HIRING)

P3 Health Partners

Manager Utilization Management

Omaha, NE · On-site

$100K - $140K/yr

P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of our Utilization Management (UM) department and help drive quality, efficiency, and compliance across ...

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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.

Manager Utilization Management

P3 Health Partners

Omaha, NE • On-site

$100K - $140K/yr

Full-time

Posted 26 days ago

Key responsibilities

  • Oversee and manage the daily operations of the Utilization Management department, including staff supervision and performance management.

  • Monitor workflows to ensure efficiency, accuracy, and compliance with regulations and organizational standards.

  • Collaborate with cross-functional teams and support organizational initiatives related to quality, compliance, and process improvement.

P3 Health Partners rating

6.6

Company rating: 6.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Lead the Team That Drives Quality, Compliance, and Exceptional Patient Care
Are you an experienced nursing leader with a passion for utilization management, operational excellence, and team development? P3 Health Partners is seeking a Utilization Management Manager to oversee the daily operations of our Utilization Management (UM) department and help drive quality, efficiency, and compliance across the organization.
In this leadership role, you'll guide a team of UM professionals, collaborate with key clinical and operational stakeholders, and play a vital role in ensuring members receive the right care at the right time. You'll have the opportunity to influence processes, mentor staff, support organizational growth, and contribute to initiatives that improve both patient outcomes and healthcare value.
What You'll Do
As the Utilization Management Manager, you'll provide leadership, oversight, and expertise to ensure the UM department operates effectively while meeting regulatory and organizational standards.
Key Responsibilities
  • Lead and manage the daily operations of the Utilization Management department, including staff supervision, coaching, and performance management.
  • Monitor departmental workflows to ensure efficiency, accuracy, and compliance with applicable regulations and organizational requirements.
  • Serve as a subject matter expert and resource for UM staff, providing ongoing education, mentorship, and support.
  • Promote a culture of quality, accountability, and continuous improvement across the department.
  • Participate in Utilization Management and Quality Assurance committees and support organizational quality initiatives.
  • Assist with preparation for and participation in audits conducted by health plans, NCQA, CMS, and other regulatory entities.
  • Collaborate with cross-functional teams including Case Management, Clinical Operations, Quality Improvement, Claims, Network Development, Configuration, and Finance.
  • Develop, implement, and maintain departmental policies, procedures, and workflow standards.
  • Identify process improvement opportunities and provide recommendations for system enhancements and operational efficiencies.
  • Maintain expertise in Medicare Advantage regulations, managed care requirements, and provider/facility contract provisions.
  • Partner with Medical Directors to support medical necessity determinations and coordination of care activities.
  • Participate in strategic planning, budgeting activities, and organizational growth initiatives.
  • Support implementation efforts related to new markets, programs, and business expansion.

What Makes You Successful
You are a collaborative healthcare leader who balances strong clinical knowledge with operational expertise and a commitment to excellence.
Core Competencies
  • Comprehensive knowledge of Medicare Advantage regulations, utilization management practices, and healthcare compliance requirements.
  • Strong leadership and team development skills.
  • Excellent verbal and written communication abilities, including presenting complex information to diverse audiences.
  • Strong organizational and project management capabilities.
  • Ability to prioritize competing demands in a fast-paced environment.
  • Sound judgment, critical thinking, and decision-making skills.
  • Ability to foster strong relationships across departments and levels of the organization.
  • Experience utilizing referral management systems, MCG criteria, CMS guidelines, and payer portals.
  • Continuous improvement mindset focused on quality, efficiency, and member outcomes.

Qualifications
Required
  • Graduate of an accredited school of nursing.
  • Active, unrestricted Registered Nurse (RN) license in the state of Arizona, California, Nebraska, Nevada, or Oregon.
  • Ability to obtain licensure in all delegated markets within one year of hire.
  • Minimum of five (5) years of clinical nursing experience.
  • Minimum of two (2) years of experience within managed care, an HMO, or a global risk-bearing provider organization.
  • Minimum of two (2) years of supervisory or management experience.
  • Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Preferred
  • Bachelor's degree in Nursing (BSN).
  • Experience leading utilization management teams within a Medicare Advantage environment.
  • Experience supporting regulatory audits and accreditation activities.

Work Hours & Travel
  • Monday - Friday; occasional oversight of Saturday/Sunday progress; 8 AM - 5 PM CT
  • This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.
  • Occassional travel to delegated markets (currently AZ, CA, NE, NV, OR).

Salary Range: $100,000 - $140,000 annually.
The posted salary range reflects P3 Health Partners' good-faith estimate for this role at the time of posting. Placement within the range will be based on qualifications, experience, education, geographic location, and internal equity considerations. In addition to base salary, eligible employees may have access to a comprehensive benefits package and other compensation opportunities.
Why Join P3?
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients. We are a physician-led organization relentless in our mission to overcome obstacles and positively disrupt the business of healthcare, transforming it from sickness care into wellness guidance.
As a Utilization Management Manager, you'll play a critical role in helping ensure our members receive high-quality, coordinated, and cost-effective care. You'll work alongside dedicated healthcare professionals and leaders who are committed to innovation, collaboration, and improving the healthcare experience for both patients and providers.
At P3, you'll have the opportunity to make a meaningful impact while growing your career in a fast-paced and evolving organization. If you are passionate about your work, eager to have fun, and motivated to be part of a mission-driven team, we encourage you to join us.
Help shape the future of healthcare while leading a team committed to clinical excellence and positive patient outcomes.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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