Job Title: Utilization Review Nurse
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. The Health Coach 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. Must reside in PA, NJ, or DE.
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.
Why Join Us?
Join a collaborative environment that values clinical insight, regulatory expertise, and continuous improvement. You’ll have the opportunity to influence quality outcomes and ensure healthcare programs meet the highest standards of care and compliance.
About Us:
Contemporary Staffing Solutions (CSS) is a trusted leader in providing contract, temporary, temp-to-hire, and direct hire staffing solutions. With decades of experience, we’ve grown from a staffing agency to a nationwide provider of workforce management solutions. Our niche recruitment expertise spans Accounting & Finance, Call Center & Office Support, Human Resources, Sales & Marketing, and Information Technology. Explore more about CSS and how we connect great talent with exceptional opportunities by visiting www.ContemporaryStaffing.com.
...across on the Internet. Partnered closely with an engineering manager, you will also work directly with engineers, as well as cross-functional... ...ideal candidate can draw from an experience operating large products at scale, navigating complex tradeoffs among multiple parties...
Description German Speaking Primary Teachers Needed in Dubai #Are you a native speaker of German?#Do you want to earn a TAX FREE income?#Do you want to teach in a well run, international school in Dubai?If you meet the criteria...
...PEL License. SUMMARY OF CLIENT'S DESCRIPTION OF THIS OPPORTUNITY: Present lessons in a comprehensive manner and use visual/audio means to facilitate learning. Provide individualized instruction to each student by promoting interactive learning. Create...
...Recreation Division, Rumpel Fitness Center, of Directorate of Family, Morale, Welfare and Recreation (DFMWR), Fort McCoy, WI.Duties:~Manages the installation's sports, fitness and aquatics programs and conducts instructional classes.~Responsible for organizing,...
...Contract Opportunity: Technical Marketing CopywriterWe're looking for a Technical Marketing Copywriter Contractor to help us tell the... ...consumers. Scope of Work - Conference presentation content: Write engaging supporting copy for slide decks to convey key messages...