Top 45 Utilization review Jobs in Chesapeake, Va

Utilization Review Specialist (Flexi)
Chesapeake Regional Medical Center —Chesapeake, VA
- Part-time
- Nursing
- Mid-level
- Case management
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Registered Nurse Senior Home Care
Confidential —Virginia Beach, VA
- $31.76 - $38.00 an hour
- Full-time
- RN License
- HIPAA
- Mid-level
- Free parking
- Mileage reimbursement
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RN Case Manager
VHS Hospice —Newport News, VA
- $70,000 - $95,000 a year
- Part-time
- Nursing
- Bachelor of Science
- Mid-level
- Dental insurance
- Tuition reimbursement
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Clinical Director
Mason Counseling Group —Portsmouth, VA
- $73,692 - $95,000 a year
- Full-time
- LMFT
- Management
- 5 years
- Health insurance
- Paid time off
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4d
Case Manager - CAC
Childrens Hospital of The Kings Daughters —Norfolk, VA
- $23.93 - $35.91 an hour
- Full-time
- Word processing
- Computer literacy
- Mid-level
Nurse Case Manager
Battelle —Norfolk, VA
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
Health Care Analyst
Intellect Solutions LLC —Portsmouth, VA
- Background check
- Mid-level
- Bachelor's degree
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Clinical Coordinator - Utilization Review
Hampton-Newport News Community Services Board —Hampton, VA
- From $62,406 a year
- Full-time
- Acute care
- Mid-level
- 3 years
- Paid holidays
- Health insurance
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Revenue Integrity Nurse Auditor
Childrens Hospital of The Kings Daughters —Chesapeake, VA
- $55.69 an hour
- Full-time
- Nursing
- RN License
- Customer service
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Chesapeake, VA
- $2,486 a week
- Weekends as needed
- Acute care
- RN License
- Hospital
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5d
Director Patient Access Services
Chesapeake Regional Healthcare Center —Chesapeake, VA
- 5 years
- Finance
- Master's degree
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VP PHARMACY OPERATIONS, Medicare Advantage Health Plan Hybrid
The French Group —Virginia Beach, VA
- Mentoring
- Organizational skills
- Senior level
Special Operations Case Manager / Nurse Case Manager (Hampton Roads, VA)
KBR —Hampton, VA
- Full-time
- Nursing
- RN License
- Military
- AD&D insurance
- Health insurance
Clinical Administrator for Developmental Disability Services
WESTERN TIDEWATER COMMUNITY SERVICES BOARD —Suffolk, VA
- $97,658 - $129,397 a year
- Full-time
- Experience working with individuals with developmental disabilities
- Mid-level
- 3 years
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Special Operations Case Manager (352 SOW Mildenhall, UK))
KBR —Suffolk, VA
- Full-time
- Nursing
- RN License
- Military
- AD&D insurance
- Disability insurance
Supervisor, MSW, Inpatient Case Management
Sentara Hospitals —Norfolk, VA
- Full-time
- LMFT
- Master of Social Work
- Licensed Clinical Social Worker
- 403(b) matching
- Paid parental leave
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Case Management Supervisor
Hampton-Newport News Community Services Board —Hampton, VA
- From $57,119 a year
- Full-time
- Adults
- Mid-level
- 3 years
- Health insurance
- Dental insurance
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8d
Manager, Care Management
Chesapeake Regional Medical Center —Chesapeake, VA
- Nursing
- RN License
- Hospital
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Special Operations Nurse Case Manager / Case Manager (Dam Neck, VA)
KBR —Virginia Beach, VA
- $74,417 - $91,365 a year
- Full-time
- Nursing
- RN License
- BLS Certification
Supervisory Psychiatrist Behavioral Health Interdisciplinary Program /Outpatient Services
US Veterans Health Administration —Chesapeake, VA
- $200,000 - $320,000 a year
- Weekends as needed
- Background check
- Medicine
- Management
- Paid holidays
- Loan repayment program

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utilization review jobs near chesapeake, va

Utilization Review Specialist (Flexi)

Chesapeake Regional Medical Center -
Chesapeake, VA

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Job Details

Part-time

Qualifications

Collaborate with healthcare professionals
Nursing
Case assessment
Care documentation
Metrics Reporting
Mid-level
Data summary reports
Records management
Case review audits
Pre-authorization review for utilization management
Data management
Case management
Utilization management
Quality improvement
Medical record abstraction
Resource utilization in healthcare
Discharge planning
Document review
Concurrent review in utilization management
LPN
Care coordination
2 years
Audit support
Documentation reviews
Nurse Licensure Compact (NLC)

Full Job Description

Summary

The Utilization Review Specialist supports the organization’s utilization management program by conducting routine admission, concurrent, and retrospective reviews utilizing established screening criteria and organizational guidelines. This position collects, reviews, and documents clinical information to support medical necessity determinations and appropriate resource utilization. Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination.

Essential Duties and Responsibilities

These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.

Conduct routine utilization reviews using approved screening criteria, established workflows, and departmental guidelines.
Collect and organize clinical documentation necessary to support utilization review activities.
Review patient records to identify required information for admission, continued stay, and discharge planning processes.
Apply established criteria to routine cases and document findings in designated systems.
Monitor assigned cases for required documentation and timely review completion.
Communicate with providers, clinical staff, payers, and care team members to obtain necessary information.
Identify cases that do not clearly meet established criteria and escalate them to an RN Utilization Review.
Present complex, high-acuity, disputed, or clinically ambiguous cases to an RN Utilization Review Specialist for evaluation and determination.
Assist with obtaining payer authorizations and tracking authorization status as directed.
Maintain accurate utilization management records, reports, and audit documentation.
Support denial prevention efforts through timely documentation and communication.
Participate in quality improvement initiatives related to utilization management processes.
Maintain knowledge of applicable payer requirements, regulatory standards, and organizational policies.
Assist with data collection and reporting related to utilization management metrics.
Perform other utilization management support duties within the scope of licensure and training.

Supervisory Responsibilities

Reports to: RN Clinical Doc Manager

Supervises: n/a

Responsibilities: n/a

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

Minimum Required Education:

Graduate of an approved healthcare program leading to licensure as a healthcare professional i.e. Licensed Practical Nurse (LPN) or other clinically licensed healthcare professionals as approved by the organization.

Experience:

Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related clinical healthcare functions may be considered.

Certificates, Licenses, Registrations:

Current unrestricted license as a Licensed Practical Nurse required at minimum in the Commonwealth of Virginia or compact state. Candidates possessing a higher level of clinical licensure are also eligible for consideration.

Certification in utilization management or case management preferred.

Physical Demands & Work Environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

utilization review jobs in chesapeake, va

Utilization Review Specialist (Flexi)

Registered Nurse Senior Home Care

RN Case Manager

Clinical Director

Case Manager - CAC

Nurse Case Manager

Health Care Analyst

Clinical Coordinator - Utilization Review

Revenue Integrity Nurse Auditor

Travel RN - Case Management/Utilization Review - Case Management

Director Patient Access Services

VP PHARMACY OPERATIONS, Medicare Advantage Health Plan Hybrid

Special Operations Case Manager / Nurse Case Manager (Hampton Roads, VA)

Clinical Administrator for Developmental Disability Services

Special Operations Case Manager (352 SOW Mildenhall, UK))

Supervisor, MSW, Inpatient Case Management

Case Management Supervisor

Manager, Care Management

Special Operations Nurse Case Manager / Case Manager (Dam Neck, VA)

Supervisory Psychiatrist Behavioral Health Interdisciplinary Program /Outpatient Services

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