Top 38 Utilization review Jobs in Norfolk, Va

Utilization Review Specialist (Flexi)
Chesapeake Regional Medical Center —Chesapeake, VA
- Part-time
- Nursing
- Mid-level
- Case management
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Health Care Analyst
Intellect Solutions LLC —Portsmouth, VA
- Background check
- Mid-level
- Bachelor's degree
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Healthcare Administrator – Virginia Beach (Operations & Compliance Focus)
Civitas Health Services —Chesapeake, VA
- $51,500 - $66,500 a year
- Full-time
- Mid-level
- 3 years
- Continuing education credits
- Disability insurance
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5d
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
Medical Records Technician (Coder/Audit/Training)
US Military Treatment Facilities under DHA —Naval Medical Center Portsmouth, VA
- $51,210 - $66,574 a year
- Online Application
- Background check
- Anatomy knowledge
- Pass drug screening
14d
Inpatient Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN - Remote in VA and NC
Sentara Health Administration, Inc. —Norfolk, VA
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- 403(b) matching
- Paid parental leave
Quick Apply
11d
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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VP PHARMACY OPERATIONS, Medicare Advantage Health Plan Hybrid
The French Group —Virginia Beach, VA
- Mentoring
- Organizational skills
- Senior level
Clinical Director
Medical Temporaries, Inc. —Virginia Beach, VA
- Full-time
- Background check
- LMFT
- Management
- Paid holidays
- Health insurance
Quick Apply
Special Operations Case Manager (352 SOW Mildenhall, UK))
KBR —Suffolk, VA
- Full-time
- Nursing
- RN License
- Military
- AD&D insurance
- Disability insurance
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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Special Operations Case Manager / Nurse Case Manager (Hampton Roads, VA)
KBR —Hampton, VA
- Full-time
- Nursing
- RN License
- Military
- AD&D insurance
- Health insurance
Medical Coding Trainer
Spectrum Healthcare Resources —Hampton, VA
- Full-time
- 5 years
- BLS Certification
- Bachelor's degree
- Paid holidays
- Health insurance
Quick Apply
4d
Clinical Director for SUD IOP Facility Aviv Recovery
Aviv Recovery —Virginia Beach, VA
- $90,000 - $105,000 a year
- Full-time
- Outpatient experience
- 3 years
- Doctor of Philosophy
- Health insurance
- Paid time off
Quick Apply
Director Patient Access Services
Chesapeake Regional Healthcare Center —Chesapeake, VA
- 5 years
- Finance
- Master's degree
Quick Apply
HCBS Supervisor, Clinical Management - Licensed
SUN BEHAVIORAL HEALTH GROUP —Virginia Beach, VA
- $65,000 - $68,000 a year
- Full-time
- Hybrid work
- Management
- Licensed Clinical Social Worker
- Adults
- Health savings account
- Disability insurance
Quick Apply
4d
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
Mental Health Clinical Director
Milestone Treatment Center —Virginia Beach, VA
- $85,000 - $100,000 a year
- Full-time
- Addiction Medicine
- Writing skills
- Licensed Clinical Social Worker
- Health insurance
- Dental insurance
Quick Apply
14d
Physician Advisor - Sentara Obici Hospital
Sentara Healthcare —Suffolk, VA
- Full-time
- Medicine
- Customer service
- BC/BE
- 403(b) matching
- Paid parental leave
Quick Apply

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utilization review jobs near norfolk, 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 norfolk, va

Utilization Review Specialist (Flexi)

Health Care Analyst

Healthcare Administrator – Virginia Beach (Operations & Compliance Focus)

Case Manager - CAC

Nurse Case Manager

Medical Records Technician (Coder/Audit/Training)

Inpatient Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN - Remote in VA and NC

Travel RN - Case Management/Utilization Review - Case Management

VP PHARMACY OPERATIONS, Medicare Advantage Health Plan Hybrid

Clinical Director

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

Case Management Supervisor

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

Medical Coding Trainer

Clinical Director for SUD IOP Facility Aviv Recovery

Director Patient Access Services

HCBS Supervisor, Clinical Management - Licensed

Supervisory Psychiatrist Behavioral Health Interdisciplinary Program /Outpatient Services

Mental Health Clinical Director

Physician Advisor - Sentara Obici Hospital

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