UTILIZATION REVIEW NURSE
Norfolk, VA · On-site +1
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse . The Utilization Review Nurse is responsible for utilization management services within the scope of licensure.
UTILIZATION REVIEW NURSE
Norfolk, VA · On-site +1
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse . The Utilization Review Nurse is responsible for utilization management services within the scope of licensure.
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K - $66K/yr
Three (3) years of experience in behavioral health, including utilization management. Key Responsibilities * Conduct utilization reviews of acute and intermediate levels of care to assess medical ...
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K - $66K/yr
Three (3) years of experience in behavioral health, including utilization management. Key Responsibilities * Conduct utilization reviews of acute and intermediate levels of care to assess medical ...
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K - $66K/yr
Three (3) years of experience in behavioral health, including utilization management. Key Responsibilities * Conduct utilization reviews of acute and intermediate levels of care to assess medical ...
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K - $66K/yr
Three (3) years of experience in behavioral health, including utilization management. Key Responsibilities * Conduct utilization reviews of acute and intermediate levels of care to assess medical ...
Utilization Review Manager (Behavioral Health Supervisor)
Fairfax, VA · On-site
$84K - $148K/yr
... CSA) Utilization Review Manager. This is an exciting time to join Fairfax-Falls Church System of Care as a member of the CSA team to meet the behavioral health needs of children and youth in our ...
Utilization Review Manager (Behavioral Health Supervisor)
Fairfax, VA · On-site
$84K - $148K/yr
... CSA) Utilization Review Manager. This is an exciting time to join Fairfax-Falls Church System of Care as a member of the CSA team to meet the behavioral health needs of children and youth in our ...
North Spring Behavioral Healthcare is looking for a fulltime Utilization Review Coordinator (on-site) to join our compassionate and dynamic team! What We Offer: * Competitive Salary * Comprehensive ...
North Spring Behavioral Healthcare is looking for a fulltime Utilization Review Coordinator (on-site) to join our compassionate and dynamic team! What We Offer: * Competitive Salary * Comprehensive ...
Two (2) years of clinical healthcare experience required. Experience in utilization review ... utilization management, case management, care coordination, discharge planning, or other related ...
Two (2) years of clinical healthcare experience required. Experience in utilization review ... utilization management, case management, care coordination, discharge planning, or other related ...
Experience Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related ...
Experience Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related ...
UTILIZATION REVIEW COORDINATOR
Danville, VA · On-site
$26 - $35/hr
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
UTILIZATION REVIEW COORDINATOR
Danville, VA · On-site
$26 - $35/hr
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...
Behavioral Technician
Fredericksburg, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Fredericksburg, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Chantilly, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Chantilly, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Chantilly, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Chantilly, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Chantilly, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Chantilly, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Fredericksburg, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Fredericksburg, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Fredericksburg, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Fredericksburg, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Utilization Specialist
Williamsburg, VA · On-site
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... behavioral or mental health, or other related health field required. • Two or more years of ...
Utilization Specialist
Williamsburg, VA · On-site
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... behavioral or mental health, or other related health field required. • Two or more years of ...
Behavioral Technician
Manassas, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Behavioral Technician
Manassas, VA · On-site
$23/hr
Overview Entry-Level Behavior Technician OR Experienced RBTs | Clinic-Based | Paid Training ... Backgrounds in childcare, education, behavioral health, or related fields Physical Requirements:
Entry Level Behavioral Health Utilization Review information
What is an entry level behavioral health utilization review?
Entry level behavioral health utilization review jobs involve assessing mental health and substance abuse treatment services to ensure they are appropriate, necessary, and covered by insurance plans. Individuals in these roles typically review clinical documentation, compare it to established criteria, and collaborate with healthcare providers to determine coverage. These positions are a starting point for those interested in behavioral health or healthcare administration, and often require strong communication, analytical skills, and a background in mental health or social services.
What are the key skills and qualifications needed to thrive as an entry level behavioral health utilization review specialist?
To thrive as an Entry Level Behavioral Health Utilization Review Specialist, you need foundational knowledge in behavioral health, familiarity with insurance processes, and often a relevant bachelor's degree in psychology, social work, or a related field. Proficiency with medical management software, electronic health records (EHRs), and familiarity with ICD-10 and DSM-5 coding systems are typically required. Strong analytical skills, attention to detail, and effective communication help you excel in reviewing clinical documentation and collaborating with providers. These skills ensure accurate, timely authorization decisions and support quality patient care while adhering to regulatory and payer guidelines.
What are some common challenges faced by entry level behavioral health utilization review professionals, and how can they be managed?
Entry-level Behavioral Health Utilization Review professionals often encounter challenges such as learning to interpret clinical documentation accurately, balancing productivity with thoroughness, and effectively communicating with providers about coverage determinations. Adjusting to the fast-paced environment and understanding complex insurance guidelines can also be demanding. Seeking mentorship from experienced colleagues, participating in ongoing training, and developing strong organizational skills are effective ways to overcome these challenges and grow within the role.
What are the most commonly searched types of Behavioral Health Utilization Review jobs in Virginia?
The most popular types of Behavioral Health Utilization Review jobs in Virginia are:
What are popular job titles related to Entry Level Behavioral Health Utilization Review jobs in Virginia?
For Entry Level Behavioral Health Utilization Review jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Entry Level Behavioral Health Utilization Review jobs in Virginia look for?
The top searched job categories for Entry Level Behavioral Health Utilization Review jobs in Virginia are:
UTILIZATION REVIEW NURSE
Norfolk, VA • On-site, Remote
Sentara Healthcare •
Hospitals • 10K+ employees10,000+ employees
6.7
Based on 414 frontline employees who took The Breakroom Quiz
532nd of 895 rated healthcare providers
People enjoy working here
Recommended by students
Good schedule notice
Respectful managers
Good training
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 5 days ago
Job description
City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
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
• 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.
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
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
• 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.
About Sentara Health
Sourced by ZipRecruiter
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Norfolk, VA, US
Year founded
1888
Website
What Sentara Health employees say
Pay
Benefits
Hours and flexibility
Workplace
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