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Free Utilization Review Training Jobs in Virginia

Maximus

Consultant - Medical (Case Reviewer 2)

VA · On-site +1

  • Medical

  • Life

  • Retirement

  • PTO

... hire). - Medical/Utilization Review experience. - Medicare Set-Aside Arrangement experience ... training, experience, expected quality and quantity of work, required travel (if any), external ...

First Division Consulting

Trainer II

Stafford, VA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide sustainment training to ensure continued operational proficiency and effective utilization ... Review training effectiveness and recommend improvements to curriculum, instructional methods, and ...

First Division Consulting

Trainer II

Stafford, VA

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide sustainment training to ensure continued operational proficiency and effective utilization ... Review training effectiveness and recommend improvements to curriculum, instructional methods, and ...

First Division Consulting

Trainer II

Stafford, VA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Provide sustainment training to ensure continued operational proficiency and effective utilization ... Review training effectiveness and recommend improvements to curriculum, instructional methods, and ...

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Showing results 21-40

All JobsFree Utilization Review Training JobsFree Utilization Review Training Jobs in Virginia

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?

AspectFree Utilization Review TrainingUtilization Review Nurse
CredentialsTypically no formal credentials required; focus on training programsRegistered Nurse (RN) license required, with possible certifications like CCM or UR-specific credentials
Work EnvironmentTraining sessions, online courses, workshopsHospitals, insurance companies, healthcare facilities
Employer & Industry UsageUsed for skill development and certification prepPerforming 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:

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:

What cities in Virginia are hiring for Free Utilization Review Training jobs?

Cities in Virginia with the most Free Utilization Review Training job openings:

Free Utilization Review Training jobs near you
Infographic showing various Free Utilization Review Training job openings in Virginia as of June 2026, with employment types broken down into 57% Full Time, 28% Part Time, 2% Temporary, 11% Contract, and 2% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution.

Cardiology, Physician Clinical Reviewer

Evolent

Arlington, VA

Other

Posted 12 days ago

Evolent rating

8.4

Company rating: 8.4 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

70th of 492 rated business services

Job description

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.

Collaboration Opportunities:  

  • Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers.

What You Will Be Doing:

  • Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.

  • Provides clinical rationale for standard and expedited appeals.

  • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.

  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.

  • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.

  • Participates in on-going training per inter-rater reliability process.

  • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.

  • On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.

Qualifications - Required and Preferred:

  • MD/DO/MBBS Degree

  • Current, unrestricted clinical license in medicine or required specialty

  • Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs

  • Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease

  • Strong clinical, management, communication, and organizational skills

  • Energetic and curious with a passion for quality and value in health care

  • Computer Proficiency

  • Minimum of five (5) years’ experience in the practice of Cardiology is preferred

  • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.

  • No history of a major disciplinary or legal action by a state medical board

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