... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...
... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...
... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...
... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...
Travel Nurse RN - Case Manager, Utilization Review - $2,150 per week
Woodbridge, VA · On-site
$2.1K/wk
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 hours per week ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Travel Nurse RN - Case Manager, Utilization Review - $2,150 per week
Woodbridge, VA · On-site
$2.1K/wk
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 hours per week ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Physician Advisor - Sentara Obici Hospital
Suffolk, VA · On-site
$180 - $230/hr
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Life Insurance • 401k/403B with Employer Match • Tuition Assistance - $5,250/year and ...
New
Physician Advisor - Sentara Obici Hospital
Suffolk, VA · On-site
$180 - $230/hr
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Life Insurance • 401k/403B with Employer Match • Tuition Assistance - $5,250/year and ...
New
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual ...
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual ...
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual ...
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual ...
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual ...
Provide education to physicians, leaders, and staff regarding utilization review, documentation ... Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual ...
Utilization Management Representative I - Backoffice Support
Norfolk, VA · On-site
$15.96 - $23.94/hr
Reviews documentation for completeness and refers cases requiring clinical review to the ... Medical terminology training and experience in medical or insurance field preferred * For URAC ...
Utilization Management Representative I - Backoffice Support
Norfolk, VA · On-site
$15.96 - $23.94/hr
Reviews documentation for completeness and refers cases requiring clinical review to the ... Medical terminology training and experience in medical or insurance field preferred * For URAC ...
Utilization Management Representative I - Backoffice Support
$15.96 - $23.94/hr
Reviews documentation for completeness and refers cases requiring clinical review to the ... Medical terminology training and experience in medical or insurance field preferred * For URAC ...
Utilization Management Representative I - Backoffice Support
$15.96 - $23.94/hr
Reviews documentation for completeness and refers cases requiring clinical review to the ... Medical terminology training and experience in medical or insurance field preferred * For URAC ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Medical Pod
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Medical Pod
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Weekdays
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Weekdays
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Medical Pod
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Medical Pod
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Weekends
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager - Weekends
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
RN Case Manager
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...
Insurance Utilization Reviewer information
What is an insurance utilization reviewer?
What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?
What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?
What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?
| Aspect | Insurance Utilization Reviewer | Insurance Claims Processor |
|---|---|---|
| Primary Role | Review medical necessity and appropriateness of services for insurance coverage | Process and review insurance claims for payment and accuracy |
| Required Credentials | Often requires healthcare or insurance certifications, such as RHIT or CPC | Typically requires claims processing or insurance certifications, like CPC or CPC-H |
| Work Environment | Healthcare settings, insurance companies, or third-party administrators | Insurance companies, healthcare providers, or claims processing centers |
| Industry Usage | Commonly employed in health insurance and managed care | Widely used across health, auto, and property insurance sectors |
The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.
What are popular job titles related to Insurance Utilization Reviewer jobs in Virginia?
For Insurance Utilization Reviewer jobs in Virginia, the most frequently searched job titles are:
- Optum Clinical Review Coordinator
- Utilization Management Nurse
- Utilization Review Physician
- Weekend Physician Advisor Utilization Review
- Home Based Utilization Review Nurse
- Remote Utilization Review Social Worker
- Manager Utilization Management
- Remote Utilization Management
- Evening Utilization Review Nurse
- No Experience Utilization Management Nurse
What job categories do people searching Insurance Utilization Reviewer jobs in Virginia look for?
The top searched job categories for Insurance Utilization Reviewer jobs in Virginia are:
What cities in Virginia are hiring for Insurance Utilization Reviewer jobs?
Cities in Virginia with the most Insurance Utilization Reviewer job openings:
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 21 days ago
Universal Health Services rating
6.9
Based on 254 frontline employees who took The Breakroom Quiz
454th of 898 rated healthcare providers
Job description
The Hughes Center is a highly-structured psychiatric residential treatment facility for youth ages 10 to 22 with neurodevelopmental disorders. The Hughes Center also provides private, community-based educational services. We provide both individualized and holistic care for adolescents and young adults with intellectual and developmental disabilities in a nurturing, family-friendly environment. We utilize a multidisciplinary team approach to provide comprehensive evaluations and evidence-based treatment (and educational) interventions with the intent to increase each youth’s level of functional independence. Our team also works diligently to address or manage medical conditions and challenging behaviors that are often associated with individuals who are diagnosed with neurodevelopmental disorders. We challenge our residents to adapt to and apply learned skills within new environments and situations, and to maintain functional use of these skills when they return to their homes or other community-based settings.
Visit us online: www.thehughescenter.com
The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when admitted, follows the chart checking that documentation reflects and meets admission, continued stay, and discharge criteria. This position interacts and communicates with clinical staff, the Business Office, Admissions, Medical Records, third party reviewers and hospital administration to help patients receive the proper hospital care that they need.
Benefit Highlights:
- Challenging and rewarding work environment
- Competitive Compensation
- Tuition Reimbursement Program
- Excellent Medical, Dental, Vision and Prescription Drug Plan
- 401(K) with company match and discounted stock plan
- Generous Paid Time Off
- Career development opportunities within UHS and its 300+ Subsidiaries
About Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 300 corporation, annual revenues were $15.8 billion in 2024. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
Qualifications
Bachelor's degree in human services; Master's degree in human services preferred. Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, or LCP in Virginia required.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
Qualifications:Bachelor's degree in human services; Master's degree in human services preferred. Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, or LCP in Virginia required.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
Education:UNAVAILABLEEmployment Type: FULL_TIMEWhat Universal Health Services employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Universal Health Services
Sourced by ZipRecruiter
Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
King of Prussia, PA, US