Job Overview:
Contemporary Staffing Solutions is seeking a Utilization Review Nurse to join our client to support the oversight and quality of delegated healthcare programs within a regulated, member-focused environment. This contract-to-hire opportunity, based in Philadelphia, PA , blends clinical knowledge with compliance expertise to ensure vendor partners meet organizational, state, and accreditation standards. This role will help strengthen care coordination processes, support performance audits, and drive initiatives that promote accountability and excellence across healthcare operations.
Compensation:
$49.23 per hour
Work Schedule:
Monday through Friday, standard business hours. Onsite Tuesday through Thursday; work from home Monday and Friday.
Key Responsibilities of the Utilization Review Nurse:
• Partner with vendor partners and internal teams to ensure delegated healthcare activities align with regulatory, accreditation, and quality standards.
• Conduct and document pre-delegation and ongoing assessments, ensuring all compliance requirements are met.
• Prepare audit findings and present reports to oversight committees, identifying trends and recommending process improvements.
• Develop, monitor, and document corrective action plans to ensure deficiencies are resolved and performance remains compliant.
• Maintain accurate records, reports, and tracking tools to support audit readiness and performance reporting.
Qualifications and Skills for the Utilization Review Nurse:
• Active, unrestricted Registered Nurse (RN) license in Pennsylvania required.
• 3–5 years of experience in healthcare compliance, accreditation, or quality assurance within managed care or health insurance settings.
• Strong understanding of ACA, Medicare Advantage, and NCQA regulations.
• Advanced Excel proficiency with ability to organize, analyze, and report complex data.
• Excellent communication, critical thinking, and organizational skills with a strong attention to detail.
...Job Description Business Intelligence Developer I Pay Range: $48/hour to $52/hour Overview We are seeking a Business Intelligence... ...At least 6 months of hands-on experience with Power BI and Tableau Strong SQL experience (MS SQL Server, Oracle, Cerner-related...
...Job Description & Requirements Oncology Nurse Practitioner or Physician Assistant(NP) StartDate: ASAP Available Shifts: Day 8 Pay Rate: $101.85 - $110.25 This facility is seeking an Oncology Nurse Practitioner or Physician Assistant(NP) for locum tenens...
...Products & Services Trends & Inspiration About Us Search Job ID: R-46374 US-Indiana -Lafayette Store Drivers Part Time Van Delivery Driver Part time Apply Now Lafayette, Indiana Share Now Hiring! Pay: $16-18/hr Store Hours - Monday...
Job Title: Scrum Master L1City: MarysvilleState/Province: OhioPosting Start Date:Wipro Limited (NYSE: WIT, BSE:, NSE: WIPRO) is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital...
...Peer-to-Peer-Beziehungen zu Fachleuten des Gesundheitswesens aufbaut und pflegt Du hast ein abgeschlossenes Masterstudium oder PhD im Bereich Medizin, Pharmazie oder anderen Naturwissenschaften ein medizinisches Fachwissen im therapeutischen Bereich (Neurologie...