Summary The Utilization Review Specialist supports the organization's utilization management ... status as directed. * Maintain accurate utilization management records, reports, and audit ...
Summary The Utilization Review Specialist supports the organization's utilization management ... status as directed. * Maintain accurate utilization management records, reports, and audit ...
Summary The Utilization Review Specialist supports the organization's utilization management ... status as directed. * Maintain accurate utilization management records, reports, and audit ...
Summary The Utilization Review Specialist supports the organization's utilization management ... status as directed. * Maintain accurate utilization management records, reports, and audit ...
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K/yr
This position will report to the Project Director of the Region 5 Reinvestment Initiative. ROLE SUMMARY The Clinical Coordinator (Utilization Review) ensures individuals receive the most appropriate ...
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K/yr
This position will report to the Project Director of the Region 5 Reinvestment Initiative. ROLE SUMMARY The Clinical Coordinator (Utilization Review) ensures individuals receive the most appropriate ...
Utilization Specialist
Williamsburg, VA · On-site
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... direct clinical experience in a psychiatric or mental health setting required. • Current ...
Utilization Specialist
Williamsburg, VA · On-site
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... direct clinical experience in a psychiatric or mental health setting required. • Current ...
Utilization Specialist - Acute
Williamsburg, VA · On-site
$24 - $28/hr
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... direct clinical experience in a psychiatric or mental health setting required. • Current ...
Utilization Specialist - Acute
Williamsburg, VA · On-site
$24 - $28/hr
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... direct clinical experience in a psychiatric or mental health setting required. • Current ...
Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... Plans, implements, and documents utilization management activities which incorporate a thorough ...
Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... Plans, implements, and documents utilization management activities which incorporate a thorough ...
Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... Plans, implements, and documents utilization management activities which incorporate a thorough ...
Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... Plans, implements, and documents utilization management activities which incorporate a thorough ...
Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... Plans, implements, and documents utilization management activities which incorporate a thorough ...
Refers appropriate cases to the Medical Director for review. Refer to and work closely with Case ... Plans, implements, and documents utilization management activities which incorporate a thorough ...
Director of Utilization Management
Danville, VA · On-site
$79K - $95K/yr
Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...
Director of Utilization Management
Danville, VA · On-site
$79K - $95K/yr
Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...
VA-Director of Pharmacy
Richmond, VA · On-site
$115K - $140K/yr
This role provides oversight for drug utilization review, medication safety programs, and pharmacy-related compliance initiatives. The Senior Director of Pharmacy collaborates closely with physicians ...
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VA-Director of Pharmacy
Richmond, VA · On-site
$115K - $140K/yr
This role provides oversight for drug utilization review, medication safety programs, and pharmacy-related compliance initiatives. The Senior Director of Pharmacy collaborates closely with physicians ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...
Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...
Clinical Director
Dumfries, VA · On-site
$125 - $135/hr
Collaborates with nursing, medical, operations, admissions, utilization review, and executive ... Direct care and administrative leadership role * Full-time on-site position with flexibility based ...
Clinical Director
Dumfries, VA · On-site
$125 - $135/hr
Collaborates with nursing, medical, operations, admissions, utilization review, and executive ... Direct care and administrative leadership role * Full-time on-site position with flexibility based ...
Clinical Director
Dumfries, VA · On-site
$125K - $135K/yr
Collaborates with nursing, medical, operations, admissions, utilization review, and executive ... Direct care and administrative leadership role * Full-time on-site position with flexibility based ...
Clinical Director
Dumfries, VA · On-site
$125K - $135K/yr
Collaborates with nursing, medical, operations, admissions, utilization review, and executive ... Direct care and administrative leadership role * Full-time on-site position with flexibility based ...
Administrative position focused on utilization review and medical necessity* Conduct medical necessity reviews and ensure compliant hospital status and billing* Lead denials management including peer ...
Administrative position focused on utilization review and medical necessity* Conduct medical necessity reviews and ensure compliant hospital status and billing* Lead denials management including peer ...
UR COORDINATOR
Danville, VA · On-site
$26 - $35/hr
... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... direct clinical experience in a psychiatric or mental health setting. Experience in patient ...
UR COORDINATOR
Danville, VA · On-site
$26 - $35/hr
... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... direct clinical experience in a psychiatric or mental health setting. Experience in patient ...
Director of Crisis Services
Richmond, VA · On-site
$85 - $110/hr
Oversees systems that support documentation integrity, billing compliance, utilization review, and ... Director of Clinical Services and Compliance Office. * Participates in executive on-call ...
New
Director of Crisis Services
Richmond, VA · On-site
$85 - $110/hr
Oversees systems that support documentation integrity, billing compliance, utilization review, and ... Director of Clinical Services and Compliance Office. * Participates in executive on-call ...
New
Director of Crisis Services
Richmond, VA · On-site
Oversees systems that support documentation integrity, billing compliance, utilization review, and ... Director of Clinical Services and Compliance Office. * Participates in executive on-call ...
Director of Crisis Services
Richmond, VA · On-site
Oversees systems that support documentation integrity, billing compliance, utilization review, and ... Director of Clinical Services and Compliance Office. * Participates in executive on-call ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... direct reports and oversight up to 50) Call Center experience preferred Utilization Manager ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... direct reports and oversight up to 50) Call Center experience preferred Utilization Manager ...
Director Optum Utilization Review information
What is the difference between Director Optum Utilization Review vs Utilization Review Manager?
| Aspect | Director Optum Utilization Review | Utilization Review Manager |
|---|---|---|
| Certifications | Typically requires certifications like CCM or URAC accreditation | Often requires similar certifications, may vary by employer |
| Work Environment | Works within Optum or similar healthcare organizations, overseeing utilization review processes | Manages utilization review teams, often within healthcare providers or insurance companies |
| Responsibilities | Strategic oversight of utilization review policies, compliance, and team leadership | Supervises daily review operations, staff management, and process improvements |
The main difference is that the Director Optum Utilization Review typically holds a higher strategic leadership role within Optum, focusing on policy and compliance, while the Utilization Review Manager manages daily operations and staff. Both roles require similar credentials but differ in scope and level of responsibility.
What are the most commonly searched types of Optum Utilization Review jobs in Virginia?
The most popular types of Optum Utilization Review jobs in Virginia are:
What are popular job titles related to Director Optum Utilization Review jobs in Virginia?
For Director Optum Utilization Review jobs in Virginia, the most frequently searched job titles are:
- Home Based Utilization Review Nurse
- Utilization Review Rn
- Optum Clinical Claim Review Nurse
- Temporary Utilization Review Nurse
- Remote Utilization Management Nurse
- Remote Utilization Review Rn
- Overnight Utilization Review Nurse
- Remote Utilization Review Nurse
- Evening Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
What job categories do people searching Director Optum Utilization Review jobs in Virginia look for?
The top searched job categories for Director Optum Utilization Review jobs in Virginia are:
- Remote Navihealth Utilization Review
- Temporary Medical Utilization Review Physician
- Therapy Utilization Review
- Remote Aetna Utilization Review Nurse
- Registered Nurse Case Review
- Director Chiropractic Utilization Review
- Remote Dental Utilization Management
- Cigna Utilization Review Nurse
- Utilization Review No Experience
- Utilization Review Case Manager
What cities in Virginia are hiring for Director Optum Utilization Review jobs?
Cities in Virginia with the most Director Optum Utilization Review job openings:
Part-time
Medical
Re-posted 14 days ago
Chesapeake Regional Healthcare rating
6.9
Based on 22 frontline employees who took The Breakroom Quiz
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.
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 notice from the Department of Labor.
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 notice from the Department of Labor.
What Chesapeake Regional Healthcare employees say
Pay
Benefits
Hours and flexibility
Workplace
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About CHESAPEAKE REGIONAL HEALTHCARE
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Chesapeake, VA, US
Year founded
1976