Top 54 Utilization review nurse Jobs in Virginia

Utilization Specialist - Acute
The Pavilion at Williamsburg Place —Williamsburg, VA
- $24 - $28 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Utilization Management Registered Nurse
Humana —Virginia
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Nurse Reviewer (Medicare)
Commence —Virginia
- $82,000 - $95,000 a year
- Online Application
- Remote
- Nursing
- RN License
- HIPAA
3d
Claims Review Nurse
Capitol Bridge, LLC. —Virginia
- $75,000 - $85,000 a year
- Remote
- Microsoft Word
- Background check
- Nursing
Quick Apply
1d
Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NC
Sentara Health Administration, Inc. —Richmond, VA
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- 403(b) matching
- Paid parental leave
Quick Apply
Sr. Nurse Reviewer (Medicare)
Commence —Virginia
- $88,000 - $115,000 a year
- Online Application
- Remote
- Nursing
- Management
- RN License
3d
Utilization Review Specialist (Flexi)
Chesapeake Regional Medical Center —Chesapeake, VA
- Part-time
- Nursing
- Mid-level
- Case management
Quick Apply
Workers Compensation - Telephonic Nurse Case Manager (Remote)
Berkley —Manassas, VA
- $75,000 - $88,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Profit sharing
- Health insurance
Special Operations Case / Nurse Case Manager Part-Time (National Capitol Region)
KBR —Alexandria, VA
- $49.31 - $54.64 an hour
- Part-time
- Nursing
- RN License
- Military
- AD&D insurance
- Disability insurance
Trauma Clinical Reviewer (Trauma Registrar)
Childrens Hospital of The Kings Daughters —Norfolk, VA
- $43.63 an hour
- Part-time
- Nursing
- RN License
- Customer service
Nurse Case Manager
Battelle —Norfolk, VA
- Full-time
- Hybrid work
- Nursing
- RN License
- BLS Certification
- Wellness program
- Health insurance
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Chesapeake, VA
- $2,526 a week
- Overtime
- Acute care
- OSHA
- RN License
Quick Apply
3d
Home Health Clinical Manager
Centerwell —Christiansburg, VA
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Registered Nurse - Unit Clinical Care Coordinator - Full Time
Valley Health —Winchester, VA
- $37.24 - $54.07 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Wellness program
- Health savings account
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —Fairfax, VA
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Registered Nurse Contract
P.I.E. Management, L.L.C. —Springfield, VA
- $64 an hour
- Full-time
- Background check
- Nursing
- Vital signs
- Health insurance
- Dental insurance
Quick Apply
8d
Home Health Clinical Manager
Centerwell —Roanoke, VA
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
RN clinical Coordinator/ Case Manager
1st Americare —Sterling, VA
- $48 - $52 an hour
- Full-time
- Nursing
- Vital signs
- RN License
Quick Apply
9d
Case Manager - Full Time
Valley Health —Winchester, VA
- $34.00 - $48.87 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Wellness program
- Health savings account
Registered Nurse (RN) Case Manager 1
Inova Health System —Leesburg, VA
- Part-time
- Nursing
- RN License
- BLS Certification
- Wellness program
- Paid parental leave

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utilization review nurse jobs near virginia

Utilization Specialist - Acute

The Pavilion at Williamsburg Place -
Williamsburg, VA

Quick Apply

Job Details

Full-time
$24 - $28 an hour

Benefits

Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance

Qualifications

Mental health facility experience
Acute care experience
Data collection

Full Job Description

Utilization Specialist - Acute | The Pavilion at Williamsburg Place | Williamsburg, Virginia

About the Job:

About the Job:

The Pavilion is looking for a Utilization Specialist to join our team!

Pay Range: $24–$28/hour
Full-time Day Shift
Complimentary Continued Education
$3000 per year Tuition Assistance

-Benefits- Medical, Dental & Vision after 30 days

Flex Pay-Daily pay option
PTO package
Much more!

PURPOSE STATEMENT:

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information; Educates hospital staff about requirements and trends.

Roles and Responsibilities:

Performs admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria. Communicates effectively with insurance companies, health maintenance organization (HMOs) and other similar entities for approval of initial or additional inpatient days for treatment. Provides information they need in a logical, concise manner using technical language that accurately describes patient’s condition and need for hospitalization.
Communicates directly with physicians and other providers with respect to specific inquires and perceived trends of issues as they relate to utilization management.
Appeals all denials ensuring accuracy of information and effective coordination of correspondence. Initiates, coordinates, and monitors the appeal process. Provides information to physicians to assist them in their role in appeals.
Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
Maintains accurate documentation and files as it relates to utilization management.
Provides ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
Communicates effectively with co-workers, program, and nursing staff regarding charting deficiencies and problems/issues identified. Follows up in each instance to determine if corrective action was taken. Notifies supervisor if corrective action is not completed.
Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
Monitors patient length of stay and extensions and informs clinical and medical staff on issues that may impact length of stay. Investigates short term length of stays and endeavor to create alternate financial planning which would offer the patient extended days of treatment. Participates in discharge planning as required.
Gathers and develops statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conducts quality reviews for medical necessity and services provided. Facilitates peer review calls between facility and external organizations. Identifies potential review problems and discuss them with multi-disciplinary team and/or administration.
Acts as liaison between managed care organizations and the facility professional clinical staff.
Assists with any problems encountered during on-site or telephone reviews by the third-party payers or review organization, when necessary.

Education/Requirements:

Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work, behavioral or mental health, or other related health field required.
Two or more years of direct clinical experience in a psychiatric or mental health setting required.
Current licensure as an LPN or RN or current clinical professional license or certification, as required, within the state where the facility provides services.

Why The Pavilion at Williamsburg Place?The Pavilion at Williamsburg Place offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. The Pavilion at Williamsburg Place is an EOE.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.

Quick Apply

Refine Your Search

utilization review nurse jobs in virginia

Utilization Specialist - Acute

Utilization Management Registered Nurse

Nurse Reviewer (Medicare)

Claims Review Nurse

Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NC

Sr. Nurse Reviewer (Medicare)

Utilization Review Specialist (Flexi)

Workers Compensation - Telephonic Nurse Case Manager (Remote)

Special Operations Case / Nurse Case Manager Part-Time (National Capitol Region)

Trauma Clinical Reviewer (Trauma Registrar)

Nurse Case Manager

Travel RN - Case Management/Utilization Review - Case Management

Home Health Clinical Manager

Registered Nurse - Unit Clinical Care Coordinator - Full Time

Hospice Clinical Team Manager (RN Required)

Registered Nurse Contract

Home Health Clinical Manager

RN clinical Coordinator/ Case Manager

Case Manager - Full Time

Registered Nurse (RN) Case Manager 1

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