ZipRecruiter

Log In

2

Flex Schedule Remote Utilization Review Jobs in Virginia

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Prestige

LPN Case Manager

Richmond, VA · Remote

$75K/yr

... utilization review * Facilitate timely and safe discharge planning * Serve as primary point of ... This is a Remote Position. * Competitive Salary * Medical, Dental, and Vision Insurance * 401K ...

Sentara Health

Benefits Coding Analyst

Richmond, VA · Remote

$10K/mo

This position is remote however, candidates must be able to commute to our Richmond location. The ... benefit and utilization review policies and criteria for emerging treatments, technology ...

Centerbrite Health

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

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

Centerbrite

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

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 ...

next page

Showing results 1-20

All JobsUtilization Review JobsFlex Schedule Remote Utilization Review JobsFlex Schedule Remote Utilization Review Jobs in Virginia

Flex Schedule Remote Utilization Review information

What is the difference between Flex Schedule Remote Utilization Review vs Flex Schedule Remote Case Manager?

AspectFlex Schedule Remote Utilization ReviewFlex Schedule Remote Case Manager
Primary RoleReview healthcare services for medical necessity and appropriatenessCoordinate patient care, develop care plans, and facilitate services
CredentialsTypically requires nursing, medical, or healthcare-related certificationsOften requires nursing, social work, or healthcare certifications
Work EnvironmentRemote, independent review setting, often within insurance or healthcare companiesRemote or hybrid, involving direct patient interaction and care coordination
Industry UsageCommon in insurance, healthcare, and utilization management sectorsCommon in healthcare, insurance, and patient advocacy sectors

Flex Schedule Remote Utilization Review focuses on evaluating medical necessity remotely, while Flex Schedule Remote Case Manager involves coordinating patient care and services. Both roles often require healthcare certifications and are performed remotely, but their core responsibilities differ in review versus patient management.

What are popular job titles related to Flex Schedule Remote Utilization Review jobs in Virginia?

For Flex Schedule Remote Utilization Review jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Flex Schedule Remote Utilization Review jobs in Virginia look for?

The top searched job categories for Flex Schedule Remote Utilization Review jobs in Virginia are:

What cities in Virginia are hiring for Flex Schedule Remote Utilization Review jobs?

Cities in Virginia with the most Flex Schedule Remote Utilization Review job openings:

Flex Schedule Remote Utilization Review jobs near you
Infographic showing various Flex Schedule Remote Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 72% Full Time, and 28% Contract. Highlights an 100% Remote job distribution.

UTILIZATION REVIEW NURSE

Norfolk, VA • On-site, Remote

Sentara Healthcare
Hospitals • 10K+ employees
Learn more about Sentara Healthcareexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

496th of 898 rated healthcare providers

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.

What Sentara Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply