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How much do utilization review 1099 jobs pay per hour?

As of Jun 1, 2026, the average hourly pay for utilization review 1099 in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Utilization Review 1099, and why are they important?

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 professionals working as 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 a Utilization Review 1099 position?

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 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 Decatur, GA? For Utilization Review 1099 jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Utilization Review 1099 jobs in Decatur, GA look for? The top searched job categories for Utilization Review 1099 jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Utilization Review 1099 jobs? Cities near Decatur, GA with the most Utilization Review 1099 job openings:
Utilization Review 1099 jobs near you
Utilization/Clinical Review RN - PRN

Utilization/Clinical Review RN - PRN

Children's Healthcare of Atlanta

Atlanta, GA • On-site

Part-time

Posted 13 days ago

Children's Healthcare Of Atlanta rating

7.3

Company rating: 7.3 out of 10

Based on 124 frontline employees who took The Breakroom Quiz

289th of 864 rated healthcare providers

Job description

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs).
Work Shift
Day
Work Day(s)
Variable
Shift Start Time
8:00 AM
Shift End Time
5:00 AM
Worker Sub-Type
PRN
Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's.
Job Description
Participates as a member of a multidisciplinary team in completing pre-screening assessments of prospective patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary documentation and communication with internal and external customers.
This role is PRN and requires (6) 8-hour days per month with 1 day being on the weekend. We'll be open to offering more if possible. Training/Orientation will be 3 days/week (8-hour days) for 8-10 weeks. Onsite Orientation is needed 3-4 days for first week. Some holidays are required as well.
This role will be remote but regular meetings/trainings will require being onsite at the Support Center in Atlanta.
Experience
  • 3 years of experience in a healthcare setting; pediatrics highly preferred

Preferred Qualifications
  • Bachelor of Science in Nursing
  • 2 years of experience in hospital or insurance related utilization review
  • Previous experience with MCG and/or InterQual systems

Education
  • Graduation from an accredited school of nursing

Certification Summary
  • Licensure as a Registered Nurse in the single State of Georgia or Multi-State through the Enhanced Nurse Licensure Compact

Knowledge, Skills, and Abilities
  • Working knowledge of financial aspects of third-party payors and reimbursement
  • Effective decision-making/problem-solving skills
  • Demonstration of creativity in problem-solving
  • Must possess above-average computer skills
  • Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of employment

Job Responsibilities
  • Provides clinical information to insurance companies as needed for completion of pre-certification process as noted in Children's Healthcare of Atlanta utilization management plan.
  • Evaluates all patients, including critical care, for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third-party information within 24 hours or next business day.
  • Initiates and facilitates physician communications relative to utilization review process when indicated without prompting and follows up to ensure completion, including peer-to-peer reviews, securing admission orders, and reporting quality issues.
  • Reviews concurrently all inpatients, including critical care, every three days or sooner if payor requests, including information regarding patient's medical condition, intensity of services being utilized, treatment plan, and established review criteria.
  • Ensures all pertinent information is documented into various systems for utilization review process.
  • Gathers and reviews relevant medical information and documents utilization review process outcome based on system accepted utilization criteria on the accepted current review forms and in computer systems.
  • Supports organizational efforts to ensure accurate capture of admission status and level of care using Epic and escalating cases for status change where necessary.
  • Refers denied cases to appropriate personnel and provides assistance and/or clinical support to aid in appeal process.
  • Serves as resource to Case Management for facilitation of patients moving to appropriate level of care and notifying when patients no longer meet medical necessity to aid in discharge planning.
  • Meets productivity (10-12 reviews/day) and quality assurance (95%) standards and demonstrates utilization review proficiency with the successful completion and passing of McKesson Interrater Reliability testing.
  • Attends all required onsite, telephonic, and mandatory department meetings.
  • Participates in department activities to help promote utilization review process, aids in denial prevention, and serves as resource to peers and team members.

Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.
Primary Location Address
1575 Northeast Expy NE
Job Family
Nursing-Non Bedside

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