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.
...based venture capital firm is seeking a mid level Compliance Officer to join their growing team! Overall Position Responsibilities... ... Administer the firms Compliance Manual, including personal securities trading reviews, outside business activity approvals, gift &...
...BHE GT&S JOB DESCRIPTION BHE is seeking a Gas Measurement Specialist for our Leidy Station in Renovo, PA RESPONSIBILITIES Install, operate, maintain, repair, and test diaphragm, rotary and turbine type positive displacement meters, orifice meter gauges...
Larimer Law in Upstate, NY is hiring remote Attorneys for new matters. THE COMPANY: Larimer Law, PLLC, has offices in Rochester... ...attorneys who are trained and experienced in electronic document review, information governance and data management. Our company works...
...with a focus on ensuring high availability, performance, and security of the Palantir environment. Location: Houton, TX preferred. Remote also works, otherwise. Pay Rate: $ per hour Client - Confidential / CTS Key Responsibilities: Administer and...
...to make the world a better place. We hire top-notch talent to develop and launch compelling, inventive communications campaigns, leveraging... ...supports building and maintaining websites in WordPress and Drupal for commercial and federal contracts. As a LAMP web developer,...