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Discharge Planner Utilization Review Jobs in Virginia

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which ...

frc

Discharge Planner/Social Worker

Roanoke, VA

$47K - $52K/yr

Participate in discharge planning, development, and implementation of social care plans and ... Review departmental complaints and grievances from personnel and make written reports to the ...

Lancesoft INC

RN Case Manager

Chesapeake, VA · On-site

$2.3K - $2.4K/wk

Discharge planning Utilization Review (UR) Experience in fast-paced surgical units EPIC charting (REQUIRED) Company Description LanceSoft is rated as one of the largest staffing firms in the US by ...

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Discharge Planner Utilization Review information

What is a discharge planner utilization review?

Discharge Planner Utilization Review professionals are healthcare workers who coordinate patient discharges from hospitals or medical facilities while ensuring appropriate utilization of healthcare services. They assess patients' continuing care needs, develop safe discharge plans, and review the necessity and efficiency of the care provided. Their role bridges clinical care and administrative requirements, helping to prevent unnecessary hospital stays and ensuring patients transition smoothly to home or other care settings. These professionals often work closely with physicians, nurses, social workers, and insurance companies to promote optimal patient outcomes and cost-effective healthcare.

How does a discharge planner utilization review collaborate with interdisciplinary teams to ensure effective patient transitions?

Discharge Planner Utilization Review professionals work closely with physicians, nurses, social workers, and insurance representatives to coordinate safe and timely patient discharges. They facilitate communication between team members, assess patients' post-hospital needs, and help secure appropriate resources such as home health care or rehabilitation services. Their role is vital in preventing readmissions by ensuring that all aspects of a patient's care plan are addressed and that transitions occur smoothly. Regular interdisciplinary meetings and case conferences are common practices to align on patient care goals.

What are the key skills and qualifications needed to thrive as a discharge planner utilization review?

To thrive as a Discharge Planner Utilization Review professional, you generally need a clinical background such as RN or social worker licensure, strong knowledge of discharge planning protocols, and familiarity with healthcare regulations. Proficiency with electronic health records (EHRs), case management software, and utilization review tools is typically required. Excellent communication, problem-solving, and organizational skills help in coordinating care and advocating for patient needs. These competencies ensure safe, efficient patient transitions and compliance with healthcare policies, ultimately optimizing patient outcomes and resource use.

What is the difference between Discharge Planner Utilization Review vs Discharge Planner?

AspectDischarge Planner Utilization ReviewDischarge Planner
Primary RoleEvaluates medical necessity and appropriateness of patient discharges for insurance and healthcare complianceCoordinates patient discharges, ensures proper placement, and communicates with healthcare teams
CredentialsTypically requires a social work, nursing, or healthcare background with certification in utilization reviewUsually requires social work or nursing credentials, with focus on discharge planning
Work EnvironmentHospitals, insurance companies, or healthcare facilities involved in utilization reviewHospitals, rehab centers, or skilled nursing facilities

While both roles involve discharge processes, Discharge Planner Utilization Review focuses on assessing medical necessity for insurance purposes, whereas Discharge Planner manages patient discharge logistics and coordination. Understanding these differences helps clarify career paths and employer expectations in healthcare settings.

What are popular job titles related to Discharge Planner Utilization Review jobs in Virginia?

For Discharge Planner Utilization Review jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Discharge Planner Utilization Review jobs in Virginia look for?

The top searched job categories for Discharge Planner Utilization Review jobs in Virginia are:

What cities in Virginia are hiring for Discharge Planner Utilization Review jobs?

Cities in Virginia with the most Discharge Planner Utilization Review job openings:

Discharge Planner Utilization Review jobs near you
Infographic showing various Discharge Planner Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 20% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Specialist (FLEXI)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Re-posted 12 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

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.
  • 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.

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.

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