Summary The Utilization Review Specialist supports the organization's utilization management ... Perform other utilization management support duties within the scope of licensure and training.
Summary The Utilization Review Specialist supports the organization's utilization management ... Perform other utilization management support duties within the scope of licensure and training.
Summary The Utilization Review Specialist supports the organization's utilization management ... Perform other utilization management support duties within the scope of licensure and training.
Summary The Utilization Review Specialist supports the organization's utilization management ... Perform other utilization management support duties within the scope of licensure and training.
Utilization Specialist
Williamsburg, VA · On-site
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... and training for staff on documentation or charting requirements, continued stay criteria and ...
Utilization Specialist
Williamsburg, VA · On-site
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... and training for staff on documentation or charting requirements, continued stay criteria and ...
Utilization Specialist - Acute
Williamsburg, VA · On-site
$24 - $28/hr
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... and training for staff on documentation or charting requirements, continued stay criteria and ...
Utilization Specialist - Acute
Williamsburg, VA · On-site
$24 - $28/hr
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... and training for staff on documentation or charting requirements, continued stay criteria and ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... Completion of an accredited residency training program * Active and unrestricted state Virginia ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... Completion of an accredited residency training program * Active and unrestricted state Virginia ...
Develops and implements program activities and services, including training and educational ... At least 2 years of experience in at least two of the following areas: utilization review ...
Develops and implements program activities and services, including training and educational ... At least 2 years of experience in at least two of the following areas: utilization review ...
Utilization Review Manager (Behavioral Health Supervisor)
Fairfax, VA · On-site
$84K - $148K/yr
Develops and implements program activities and services, including training and educational ... At least 2 years of experience in at least two of the following areas: utilization review ...
Utilization Review Manager (Behavioral Health Supervisor)
Fairfax, VA · On-site
$84K - $148K/yr
Develops and implements program activities and services, including training and educational ... At least 2 years of experience in at least two of the following areas: utilization review ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... Assists with training and special projects, as assigned. * Consistently demonstrates high standards ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... Assists with training and special projects, as assigned. * Consistently demonstrates high standards ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... Assists with training and special projects, as assigned. * Consistently demonstrates high standards ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... Assists with training and special projects, as assigned. * Consistently demonstrates high standards ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... Assists with training and special projects, as assigned. * Consistently demonstrates high standards ...
May perform clinical review telephonically, electronically, or on-site, depending on customer and ... Assists with training and special projects, as assigned. * Consistently demonstrates high standards ...
Utilization Review Manager (Behavioral Health Supervisor)
Fairfax, VA · On-site
$84K - $148K/yr
Develops and implements program activities and services, including training and educational ... At least 2 years of experience in at least two of the following areas: utilization review ...
Utilization Review Manager (Behavioral Health Supervisor)
Fairfax, VA · On-site
$84K - $148K/yr
Develops and implements program activities and services, including training and educational ... At least 2 years of experience in at least two of the following areas: utilization review ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... Complete training and continuing education as deemed necessary * Attend and participate in ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... Complete training and continuing education as deemed necessary * Attend and participate in ...
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and ... Free onsite parking * 24/7 armed security to ensure your safety * Tuition reimbursement * Onsite ...
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and ... Free onsite parking * 24/7 armed security to ensure your safety * Tuition reimbursement * Onsite ...
RN Case Manager - Utilization Management - Part Time
Fishersville, VA · On-site
$35.43 - $54.21/hr
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and ... Free onsite parking * 24/7 armed security to ensure your safety * Tuition reimbursement * Onsite ...
RN Case Manager - Utilization Management - Part Time
Fishersville, VA · On-site
$35.43 - $54.21/hr
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and ... Free onsite parking * 24/7 armed security to ensure your safety * Tuition reimbursement * Onsite ...
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and ... Free onsite parking * 24/7 armed security to ensure your safety * Tuition reimbursement * Onsite ...
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and ... Free onsite parking * 24/7 armed security to ensure your safety * Tuition reimbursement * Onsite ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
UR COORDINATOR
Danville, VA · On-site
$26 - $35/hr
... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... Free meals! * Company stock purchase discount * Employee Assistance Program The Hughes Center is a ...
UR COORDINATOR
Danville, VA · On-site
$26 - $35/hr
... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... Free meals! * Company stock purchase discount * Employee Assistance Program The Hughes Center is a ...
Developmental Services Lead Support Coordinator
Ruther Glen, VA · On-site
$20 - $26/hr
Will supervise Support Coordinators, Conducts quality assurance, utilization review, training ... RACSB maintains a drug-free workplace environment. All candidates who receive conditional offers of ...
Developmental Services Lead Support Coordinator
Ruther Glen, VA · On-site
$20 - $26/hr
Will supervise Support Coordinators, Conducts quality assurance, utilization review, training ... RACSB maintains a drug-free workplace environment. All candidates who receive conditional offers of ...
Travel Case Manager - $2,526 per week
Chesapeake, VA · On-site
$2.5K/wk
Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review ...
Travel Case Manager - $2,526 per week
Chesapeake, VA · On-site
$2.5K/wk
Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review ...
Free Utilization Review Training information
What is free utilization review training?
Free utilization review training refers to educational programs or courses that teach individuals the fundamentals of utilization review without requiring payment. Utilization review is a process used in healthcare to assess the necessity, efficiency, and appropriateness of medical services, procedures, or admissions. These free training options are often available online and can help nurses, case managers, or other healthcare professionals gain the skills needed to pursue roles in utilization management. Training typically covers topics such as clinical guidelines, insurance protocols, and regulatory compliance. Completing such training can enhance career opportunities in healthcare case management and insurance settings.
What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?
To thrive as a Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and knowledge of insurance and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and possibly certifications like Certified Utilization Review Nurse (CURN) are typically expected. Excellent communication, analytical thinking, and attention to detail are standout soft skills in this position. These abilities are crucial for ensuring appropriate patient care, compliance, and cost-effective healthcare delivery.
What are some common challenges faced by professionals during utilization review training, and how can they be overcome?
During utilization review training, professionals often encounter challenges such as adapting to complex healthcare regulations, learning to interpret medical records efficiently, and effectively applying clinical guidelines to decision-making. Overcoming these challenges requires strong attention to detail, ongoing engagement with training modules, and seeking mentorship from experienced utilization review nurses or case managers. Actively participating in case discussions and staying updated with industry standards can also help trainees build confidence and competence for a successful career in utilization review.
What is the difference between Free Utilization Review Training vs Utilization Review Nurse?
| Aspect | Free Utilization Review Training | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically no formal credentials required; focus on training programs | Registered Nurse (RN) license required, with possible certifications like CCM or UR-specific credentials |
| Work Environment | Training sessions, online courses, workshops | Hospitals, insurance companies, healthcare facilities |
| Employer & Industry Usage | Used for skill development and certification prep | Performing reviews, making coverage decisions, ensuring appropriate care |
Free Utilization Review Training provides foundational knowledge and skills for those interested in entering or advancing in utilization review roles. In contrast, a Utilization Review Nurse is a licensed healthcare professional actively performing review duties in clinical settings. The training is often a prerequisite or supplement to the nurse's practical work, which requires licensure and clinical experience.
How to become a free utilization review training?
To pursue free utilization review training, individuals can seek online courses, webinars, or workshops offered by healthcare organizations or professional associations. Gaining knowledge of medical terminology, insurance processes, and review protocols is essential, and some programs may require prior healthcare experience or certification in related fields.
What are popular job titles related to Free Utilization Review Training jobs in Virginia?
For Free Utilization Review Training jobs in Virginia, the most frequently searched job titles are:
- Remote Utilization Review Nurse
- Non Exempt No Experience Utilization Management Nurse
- Utilization Review Physician
- Weekend Physician Advisor Utilization Review
- Evening Utilization Review Nurse
- No Experience Utilization Management Nurse
- Therapist Utilization Review Remote
- Night Shift Remote Utilization Review Nurse
- Remote Utilization Management Nurse
- Remote Utilization Review Rn
What job categories do people searching Free Utilization Review Training jobs in Virginia look for?
The top searched job categories for Free Utilization Review Training jobs in Virginia are:
- Lpn Utilization Review
- Flex Schedule Utilization Review
- Assistant Remote Utilization Review
- Remote Cigna Utilization Review Nurse
- Director Of Utilization Review
- Utilization Review
- Temporary Medical Utilization Review Physician
- Manager Aetna Utilization Review
- Volunteer Navihealth Utilization Review
- Remote Utilization Review
What cities in Virginia are hiring for Free Utilization Review Training jobs?
Cities in Virginia with the most Free Utilization Review Training job openings:
Part-time
Medical
Re-posted 12 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
Get the full story on Breakroom
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