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Chart Utilization Review Jobs in Washington (NOW HIRING)

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of ...

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of ...

Woodley House

Clinical Program Manager

Washington, DC · On-site

$60K - $68K/yr

... utilization review, authorization requests, discharge planning, and coordination with psychiatric ... chart reviews, overseeing program practices, and maintaining compliance with agency policies ...

VITAS Healthcare

Team Manager Home Care

Fairfax, VA · On-site

Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...

VITAS Healthcare

Team Manager Home Care

Fairfax, VA · On-site

Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...

UHS

Director of Social Work

Washington, DC

... chart, which includes identification of psychosocial factors with high-risk potential, social ... Monitors insurance requirements and keeps utilization reviewer and other treatment team members ...

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Chart Utilization Review information

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.

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 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.

What are popular job titles related to Chart Utilization Review jobs in Washington? For Chart Utilization Review jobs in Washington, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Washington look for? The top searched job categories for Chart Utilization Review jobs in Washington are:
What cities in Washington are hiring for Chart Utilization Review jobs? Cities in Washington with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Washington as of July 2026, with employment types broken down into 2% As Needed, 78% Full Time, 18% Part Time, and 2% Contract. Highlights an 92% Physical, 4% Hybrid, and 4% Remote job distribution.
Utilization Management Nurse - Emergency Department

Utilization Management Nurse - Emergency Department

Luminis Health

Annapolis, MD

Other

Posted 19 days ago

Luminis Health rating

8.1

Company rating: 8.1 out of 10

Based on 52 frontline employees who took The Breakroom Quiz

69th of 890 rated healthcare providers

Job description

Position Objective:  Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.  

Essential Job Duties:

1. Chart Review:

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC

2. Denial Management:

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial;  assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.

3. Care Coordination:

Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.

4.  Process improvement initiatives

Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.

Educational/Experience Requirements:

  • Bachelor's of Science in Nursing or Associate's degree in Nursing with equivalent experience.  BSN must be achieved within 5 years of start date in the role.  
  • Three years of clinical nursing in an acute care hospital setting.

RequiredLicense/Certifications:

  • Current RN license from Maryland Board of Nursing.

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.

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