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Chart Utilization Review Jobs in Virginia (NOW HIRING)

Summit BHC

Utilization Assistant

Williamsburg, VA · On-site

Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their ... the chart to supervisor immediately to ensure timely resolution of problems. • Responds to ...

UHS

Director of Utilization Management

Danville, VA · On-site

... chart checking that documentation reflects and meets admission, continued stay, and discharge ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provides feedback to the health care team verbally and via chart entries regarding the patient ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provides feedback to the health care team verbally and via chart entries regarding the patient ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provides feedback to the health care team verbally and via chart entries regarding the patient ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provides feedback to the health care team verbally and via chart entries regarding the patient ...

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Chart Utilization Review information

How to make 150,000 as a nurse?

To earn $150,000 as a nurse, professionals often pursue advanced roles such as nurse anesthetist, nurse practitioner, or clinical nurse specialist, which typically require additional certifications and education like a master's or doctoral degree. Gaining specialized skills, working in high-demand settings, and accumulating experience can also help increase earning potential, often involving overtime or night shifts. Salary levels vary by location and employer, but advanced practice roles generally offer higher compensation within the nursing field.

What are the key skills and qualifications needed to thrive as a Chart Utilization Review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

How to become a chart reviewer?

To become a chart reviewer, typically one needs a healthcare-related degree such as nursing, medical assisting, or health information management, along with experience in medical record documentation. Familiarity with electronic health record (EHR) systems and attention to detail are essential, and some positions may require certification in health information management or coding. On-the-job training is common, and strong organizational skills are important for reviewing and ensuring accurate chart documentation.

What is Chart Utilization Review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in Chart Utilization Review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What jobs pay 2000 a day?

Jobs that can pay $2,000 a day typically include specialized roles such as senior consultants, high-level project managers, certain medical specialists, and experienced freelance professionals in fields like software development or finance. These positions often require advanced skills, certifications, or extensive experience, and may involve consulting, contract work, or leadership responsibilities. Such high daily rates are usually associated with independent contractors or roles in high-demand industries.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

How to make an extra $2000 a month as a nurse?

A nurse can increase income by taking on per diem or overtime shifts, working in high-demand specialties, or obtaining additional certifications such as CCRN or CNOR to qualify for higher-paying roles. Freelance consulting, teaching, or telehealth services can also supplement income outside regular hours.
What are popular job titles related to Chart Utilization Review jobs in Virginia? For Chart Utilization Review jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Virginia look for? The top searched job categories for Chart Utilization Review jobs in Virginia are:
What cities in Virginia are hiring for Chart Utilization Review jobs? Cities in Virginia with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Virginia as of June 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Utilization Review/Continuous Quality Improvement Specialist

Frederick County, VA

Winchester, VA • On-site

$65K - $75K/yr

Full-time

Medical, Dental, Vision, Life

This job post has expired today. Applications are no longer accepted.

Job description

Salary: $65,280.00 - $75,000.00 Annually
Location : 107 N Kent. St., Winchester, VA
Job Type: Full-Time
Job Number: 00710
Department: CHILDREN'S SERVICES ACT
Opening Date: 05/26/2026
Description
We are seeking a detail-oriented and clinically driven UR/CQI Specialist to support quality assurance and continuous improvement efforts for Children's Services Act (CSA) programs. This role is responsible for reviewing high-risk and complex cases and ensuring that services are effective, family-centered, and compliant with CSA requirements and local policies. The ideal candidate will bring strong analytical skills, clinical expertise, and a commitment to improving outcomes for youth and families through collaboration, provider oversight, and data-informed recommendations.
What You'll Do:
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Conduct utilization reviews for CSA-funded youth and family cases, including congregate care placements, high-utilization services, and other high-risk or clinically complex cases.
  • Review assessments, CANS, IFSPs, treatment plans, progress reports, and related documentation to ensure services are clinically appropriate, effective, and least restrictive and aligned with identified needs and CSA expectations.
  • Assess whether services are clinically appropriate, least restrictive, fiscally responsible, and responsive to the youth and family's documented needs, strengths, functioning, and treatment goals.
  • Conduct interviews and gather information from youth, families, caregivers, case managers, service providers, and partner agencies to support utilization review and continuous quality improvement efforts.
  • Prepare written UR/CQI findings, summaries, and recommendations, and provide professional guidance to FAPT, IFT, and other multidisciplinary teams regarding level of care, treatment progress, discharge planning, service alternatives, and service gaps.
  • Monitor provider compliance with contractual expectations, treatment planning requirements, monthly reporting standards, incident reporting, licensing concerns, and overall quality-of-care expectations through chart reviews, provider meetings, and site visits.
  • Track service utilization patterns, treatment outcomes, provider performance concerns, and systemic barriers to support continuous quality improvement initiatives, outcome monitoring, and programmatic enhancements.
  • Provide consultation and technical assistance related to CANS-informed service planning, evidence-based interventions, progress monitoring, discharge planning, audits, policy implementation, training activities, and confidentiality compliance.
  • Maintains confidential records and communications in accordance with CSA requirements, local policies, HIPAA/FERPA, where applicable, and other confidentiality requirements.
  • Performs other duties as assigned.

What We're Looking For:
EDUCATION: Master's Degree in Social Work, Counseling, Psychology, Marriage and Family Therapy, Human Services, or a closely related field required.
EXPERIENCE: Minimum one year of experience in behavioral health, child welfare, juvenile justice, special education, or children's services required. Experience with utilization review, treatment planning, residential care, Medicaid behavioral health services, CSA, CANS, or provider quality assurance preferred. Related internship experience may be considered.
CERTIFICATES, LICENSES AND/OR REGISTRATIONS: Clinical license or license-eligible status in Virginia preferred. Must be proficient in the CANS and become certified as a CANS SuperUser within 30 days of employment or within the timeframe approved by the CSA Coordinator. Must possess a valid driver's license.
OTHER KNOWLEDGE, SKILLS AND ABILITIES: Requires strong clinical assessment, documentation review, analytical, written, and verbal communication skills. Ability to interpret and apply complex policies, contracts, and treatment documentation while exercising sound clinical judgment in time-sensitive situations. Must collaborate effectively with families, providers, and partner agencies, manage conflict professionally, and work independently under strict deadlines. Proficiency with Microsoft 365 and standard office technology required. Knowledge of CSA, CANS, Medicaid behavioral health services, evidence-based practices, and licensing standards preferred.
Supplemental Information
PHYSICAL DEMANDS: Requires regular physical activity, including walking, standing, sitting, writing, typing, bending, and operating office equipment. Work involves preparing and analyzing data and observing community and service settings. Must be able to travel independently to provider sites, schools, courts, homes, and other community locations approximately 25-50% of the time.
ENVIRONMENTAL CONDITIONS: Primary workspace is a heated and air-conditioned office. Duties require travel to provider locations, schools, homes, meetings, and other community settings as assigned. In-person attendance at FAPT, provider meetings, site visits, and other meetings may be required based on operational needs.
To learn more about Frederick County, Virginia employee benefits, please visit the following webpage:
All positions are subject to a criminal background check for any convictions that relate to the job duties and responsibilities. Frederick County Virginia Government is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
The County's EEO Utilization Report is available at www.fcva.us/jobs
There are a wide variety of benefits available to Frederick County employees. These benefits include: health, dental, vision, life insurance, optional life and disability plans, flexible spending account for health care, dependent care assistance program, an employee assistance program and a deferred compensation program.
Please click to view our Frederick County Employee Benefits information page with full details on all insurance plans offered.

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