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.
...Resource is seeking an experienced marketer to lead our brand through growth and deepen our client experiences. In this role, you will shape and implement the marketing strategy to ensure extreme client service is accomplished through marketing efforts. Youll collaborate...
...omnichannel ecommerce marketing with marketplace management. We create and implement holistic media... .../monthly calls. Regular communication of ad spend/sales and adjustments being made... ...types and experience across Google Ads, Facebook, and other digital platforms....
Personal Stylist, Baybrook - Full Time Friendswood, TX, United States Full time Schedule $20.00-$35.00 Hourly Rate** based on job, location, and schedule Job Description Be part of an amazing story Macys is more than just a store. Were...
...Primary Care Physician (MD/DO) Concierge or Functional & Integrative Medicine Richmond, Virginia | On-site | Full-Time | $240k-$325k We are recruiting a seasoned Primary Care Physician (MD/DO) to join a premium, relationship-focused clinical model that embraces...
...The candidate must have 4 -10 years experience as an Assistant PM or Project Manager in Heavy Industrial and Institutional Construction with a background in mechanical process piping and advanced plumbing systems. Past project size should exceed $2 million Fully...