ZipRecruiter

Log In

2

Director Remote Utilization Review Jobs in Virginia

McGuireWoods LLP

Director, Benefits

Richmond, VA · On-site +1

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

McGuireWoods LLP

Director, Benefits

Richmond, VA · On-site +1

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse ... utilization review, or managed care experience; or any combination of education and experience ...

Centerbrite Health

BCBA

Fairfax, VA · On-site +1

$90K - $110K/yr

Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ... Clinical Director track: this role is built to grow into clinical leadership as the organization ...

Toole Design

Planning Director - Mid-Atlantic

Richmond, VA · On-site +1

$130K - $155K/yr

Richmond, VA (remote to start); or Northern Virginia (remote to start). Why You'll Love Working ... You'll support and mentor our 13 planners across the region, balance workloads and utilization, and ...

Toole Design

Planning Director - Mid-Atlantic

Arlington, VA · On-site +1

$140K - $170K/yr

Richmond, VA (remote to start); or Northern Virginia (remote to start). Why You'll Love Working ... You'll support and mentor our 13 planners across the region, balance workloads and utilization, and ...

Centerbrite Health

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

next page

Showing results 1-20

All JobsUtilization Review JobsDirector Remote Utilization Review JobsDirector Remote Utilization Review Jobs in Virginia

Director Remote Utilization Review information

What is the difference between Director Remote Utilization Review vs Utilization Review Nurse?

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

What is a Director of Remote Utilization Review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

How does a Director of Remote Utilization Review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What are the key skills and qualifications needed to thrive as a Director of Remote Utilization Review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.
What are the most commonly searched types of Remote Utilization Review jobs in Virginia? The most popular types of Remote Utilization Review jobs in Virginia are:
What cities in Virginia are hiring for Director Remote Utilization Review jobs? Cities in Virginia with the most Director Remote Utilization Review job openings:
Director Remote Utilization Review jobs near you
Cloud Platform Maintenance Director (Remote)

Cloud Platform Maintenance Director (Remote)

Oxley Enterprises®, Inc.

Stafford, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 4 days ago

Job description

The following states/districts are excluded from this job ad: AK, CA, CO, CT, DC, HI, LA, MA, MN, MO, NE, NV, NH, NJ, NM, NY, ND, OR, PR, RI, VT, WA, WY
Future Need - Actively Interviewing
Location: Remote in any United States jurisdiction not excluded from this job advertisement.
Drive the technical excellence of a 24/7 Amazon Web Services (AWS) platform serving millions of Veterans. As the Maintenance Technical Director, you support architecture, engineering, and maintenance activities supporting mission-critical applications for the Department of Veterans Affairs (VA).
Position Description: The Cloud Platform Maintenance Director supports the architecture, engineering, and maintenance of a healthcare platform while overseeing AWS cluster management, code governance, configuration management, certificate management, change control, and delivery of major technical artifacts.
Minimum/General Experience: 10 years of experience in cloud platform engineering and technical leadership
Minimum Education: Bachelor's Degree in computer science, information technology, systems engineering or related field
Essential Skills/Qualifications:
  • Expert experience providing technical leadership for complex enterprise cloud platforms and mission-critical systems in an Agile SAFe environment
  • Expert experience in system sustainment, platform engineering, and operational reliability practices
  • Expert experience with AWS Elastic Kubernetes Service (EKS) cluster management, node operations, Amazon Machine Images (AMI) governance, and Kubernetes platform engineering
  • Expert knowledge of AWS managed services (e.g., EKS, Relational Database Services/RDS, ElastiCache, DocumentDB, Kinesis, MSK, Athena)
  • Expert ability to lead platform architecture design including high-level design (HLD) and low-level design (LLD) documentation, multi-region strategies, and system dependency mapping
  • Excellent experience with Infrastructure as Code (IaC) using Terraform
  • Excellent experience enforcing 100% IaC provisioning and automated drift detection
  • Excellent knowledge of EC2-based services (e.g., Consul, Vault, MongoDB, Atlassian, Active Directory, Nexus, Postfix)
  • Excellent understanding of Public Key Infrastructure (PKI) operations, TLS certificate lifecycle management, and secrets management using Vault and AWS Secrets Manager
  • Above average experience with Change Control Board (CCB) facilitation, ServiceNow integration, and production change governance
  • Knowledge of VA Technical Reference Model (TRM) compliance and VA Enterprise Architecture standards
  • Knowledge of PI-level planning for platform engineering teams
  • Experience supporting Federal Government programs and large-scale enterprise applications operating in cloud-based or hybrid environments
  • Excellent verbal and written communication skills

General Physical Requirements needed to perform the essential functions of this job may vary based on the location of the assignment.
  • Assignment Location - Remote
  • Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
  • Typing, communicating, repetitive motions.
  • Close visual acuity to prepare and analyze data, view computer monitors and read. May need to view presentation screens and other visual aids in a virtual setting.
  • Inside environmental conditions with protection from outside elements.

Security: Active Federal Civilian Public Trust clearance
  • U.S. Citizenship or Permanent Resident that has lived in the United States for at least 3 years

Federal Civilian Public Trust Consists of a review of up to but not limited to:
  • Covers 10 year period and in some instances lifetime events
  • OPM Security Investigations Index (SII)
  • DOD Defense Central Investigations Index (DCII)
  • National Agency Check (NAC) records
  • FBI name check
  • FBI fingerprint check
  • Credit report check
  • Written inquiries to previous employers and references listed on the application for employment
  • Potential interviews with the subject, spouse, neighbors, supervisor, coworkers
  • Law enforcement check
  • Court records check
  • Education check - Attendance and Degrees

Tasks/Activities include, but are not limited to:
  • Maintains regular communication with the Contracting Officer's Representative (COR) and Government technical leadership
  • Provides senior technical oversight for all architecture, engineering, and maintenance activities ensuring 99.995% incident-free availability for mission-critical applications
  • Delivers and maintains the Architecture Package (HLD/LLD), architecture, engineering, and maintenance assessment, and maintenance plan within contractual timelines
  • Leads the design and delivery of the Scheduling Event Bus to production, supporting enterprise scheduling across VistA and other healthcare applications
  • Develops and implements the Multi-Region Enablement Plan including failover strategies, Recovery Time Objective (RTO)/Recovery Point Objective (RPO) definitions, and cost modeling for VA AWS GovCloud US-West and US-East environments
  • Enforces 100% IaC provisioning via Terraform and ensures configuration drift detection runs at least weekly and is remediated within 3 business days
  • Oversees certificate lifecycle management ensuring 100% of TLS certificates are renewed 30+ days prior to expiration using automated mechanisms
  • Facilitates daily Change Control Board (CCB) meetings and ensures 100% of production changes are executed within Government-approved change windows with documented backout plans
  • Delivers Monthly Maintenance Reports tracking all performance standards
  • Identifies and escalates any objectives not meeting expectations
  • Ensures all platform software operates on VA TRM-approved versions with no End-of-Life/End-of-Support (EOS) software in production

Compensation & Benefits: The annual projected pay range for this position is $113,585 - $150,164 with consideration being given to various factors including but not limited to qualifications, experience, job responsibilities, and geographic location.
Oxley Enterprises, Inc. offers a full array of benefits including:
  • Medical, dental, vision and prescription drug coverage for you and your family.
  • Life Insurance, short-term disability and long-term disability paid for by the Company.
  • Supplemental coverages including Accident, Critical Illness, and Hospital.
  • Additional Life insurance coverage for you and your dependents.
  • 401k plan with various options to select based on your retirement goals.

Oxley Enterprises®, Inc. is a certified service-disabled veteran-owned (SDVOSB), veteran-owned (VOSB), and woman-owned small business (WOSB) that has 26 years of experience building and delivering quality IT systems and programs. Oxley is ranked in the INC 5000 7 times (2016, 2017, 2018, 2021, 2023, 2024, 2025). Oxley is a 2019 - 2025 Department of Labor HIRE Vets Medallion Award Winner. Oxley is Virginia Values Veterans certified.
All qualified applicants will receive consideration for employment without regard to any status protected by applicable federal, state, or local law.
If you require a reasonable accommodation to apply for a position at Oxley Enterprises, Inc., please send an email to our Human Resources Department at: with the following information:
Subject Line: Accommodation Request
Provide a description of your accommodation request
Include your contact information: Full name, Email address, Best number to reach you (optional)
We participate in the E-Verify program.

Apply