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.
...Entry Level Property Accountant Step into a dynamic real estate accounting role designed for ambitious early-career professionals. As an Entry-Level Property Accountant, youll build hands-on experience across property financials, asset tracking, and monthly reporting...
...Job Description Job Description Local Delivery Driver Makhni Bros Inc. Hicksville NY Contracted service provider for FedEx Ground. Qualifications Candidates must pass a drug test and background check Experience in driving Box Trucks is a prerequisite...
...seeking an energetic, reliable, and experienced Group Fitness Instructor to join our team as a substitute instructor , with the possibility... ...e.g., Pilates, Barre, Zumba, Yoga, Cycling, etc.). Current CPR/AED certification (required). Strong communication and...
...Fitness InstructorJoin us at The Little Gym of Issaquah and bring your energy, love of... ...and teaching method (well train you!).Be part of a team of instructors who teach classes... ...level: Entry levelEmployment type: ParttimeJob function: OtherIndustry: Wellness...
...this department. Ensures staff members have adequate training to complete key areas of responsibility. Ensures that the OA and CTS contracts exceed goals. Promotes positive Job Corps image and awareness in the community. Develops referral services. Recruits...