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Cvs Health Utilization Management Jobs in Virginia

Humana

Utilization Management RN

Richmond, VA · On-site

The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... This role will report directly to the Manager, Utilization Management. Key Responsibilities:

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

Career development opportunities within UHS and its 300+ Subsidiaries About Universal Health ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...

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Cvs Health Utilization Management information

What is CVS Health Utilization Management?

CVS Health Utilization Management refers to a set of services and processes used to ensure that patients receive appropriate, effective, and efficient health care. This involves reviewing medical necessity, appropriateness, and efficiency of health care services, procedures, and facilities under the provisions of a health benefits plan. At CVS Health, Utilization Management professionals work with healthcare providers, payers, and patients to optimize care outcomes while controlling costs. They help determine coverage decisions, coordinate care, and assist in managing complex cases.

What is the difference between Cvs Health Utilization Management vs Cvs Health Case Management?

AspectCvs Health Utilization ManagementCvs Health Case Management
Primary FocusReviewing and authorizing healthcare services to ensure appropriate utilizationCoordinating patient care and connecting patients with resources
Work EnvironmentUtilization review teams, insurance settingsPatient homes, healthcare facilities, community settings
CredentialsRN, LPN, or other healthcare certificationsRN, social worker, or case management certifications
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers

While both roles involve healthcare professionals, Utilization Management focuses on reviewing services for appropriateness, whereas Case Management emphasizes coordinating comprehensive patient care. Understanding these differences helps in choosing the right career path or job search focus within the healthcare industry.

What are some typical challenges faced by CVS Health Utilization Management professionals, and how can they be addressed?

Utilization Management professionals at CVS Health often encounter challenges such as balancing clinical decision-making with cost-effectiveness, managing high caseloads, and navigating complex insurance policies. Staying updated on healthcare regulations, maintaining clear communication with providers, and leveraging the company's decision-support tools can help address these challenges. Regular collaboration with interdisciplinary teams also ensures that patient care remains the top priority while meeting organizational guidelines.

What are the key skills and qualifications needed to thrive in CVS Health Utilization Management?

To thrive as a CVS Health Utilization Management Nurse, you need a current RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of insurance guidelines and regulatory requirements is typically expected. Excellent communication, attention to detail, and critical thinking skills help in advocating for patients and collaborating with healthcare providers. These skills ensure effective care coordination, compliance with policies, and optimized patient outcomes in a managed care environment.
What are the most commonly searched types of Cvs Health Utilization Management jobs in Virginia? The most popular types of Cvs Health Utilization Management jobs in Virginia are:
What are popular job titles related to Cvs Health Utilization Management jobs in Virginia? For Cvs Health Utilization Management jobs in Virginia, the most frequently searched job titles are:
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What cities in Virginia are hiring for Cvs Health Utilization Management jobs? Cities in Virginia with the most Cvs Health Utilization Management job openings:
Cvs Health Utilization Management jobs near you
Infographic showing various Cvs Health Utilization Management job openings in Virginia as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 72% In-person, 14% Hybrid, and 14% Remote job distribution.

Behavior Health Utilization Management Care Coordinator

Sentara Healthcare

Woodbridge, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 398 frontline employees who took The Breakroom Quiz

491st of 887 rated healthcare providers

Job description

City/State
Woodbridge, VA
Work Shift
First (Days)
Overview:
Sentara Health is looking to hire a Behavior Health Utilization Management Care Coordinator
Standard working hours: 8am to 5pm EST, MF
This position will work with members under Sentara Health Plans who are both medically and behaviorally complex.
This position requires both in-person/face-to-face assessments and remote telephonic assessments for members with Serious Mental Illnesses, Serious Emotional Disturbances (ages 2+) and Substance Abuse Disorders!
Location: Applicants must be in Winchester, Stephens City, Leesburg, Fairfax, Chantilly, Front Royal, and Alexandria, VA. Travel may include up to 90 minutes one way.
Education:
  • Bachelor's degree (required)

Certification/Licensure:
Required license must be valid in state of practice. One of the following:
  • Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Clinical Social Worker (LCSW) - State license - North Carolina Social Work Certification and Licensure Board (NCSWCLB) OR
  • Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Professional Counselor (LPC) - State license - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) OR
  • Licensed Marriage and Family Therapist (LMFT) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Marriage and Family Therapist (LMFT) - State license - North Carolina Marriage and Family Therapy Licensure Board (NCBMFT) OR
  • Licensed Substance Abuse Treatment Practitioner (LSTAP) - State license - Virginia Department of Health Professionals (VADHP)
  • Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON)

Experience
  • 2 years of behavioral health (Required)
  • 1 year of case management (Required)

Keywords: Talroo- Health, LCSW, LPC, NCBLCMHC, LMFT, NCBMFT, LSTAP, RN, Care Coordinator, Behavioral Health
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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