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.
New
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.
New
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 ...
Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K - $66K/yr
Three (3) years of experience in behavioral health, including utilization management.Key ResponsibilitiesConduct utilization reviews of acute and intermediate levels of care to assess medical ...
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Clinical Coordinator - Utilization Review
Hampton, VA · On-site
$62K - $66K/yr
Three (3) years of experience in behavioral health, including utilization management.Key ResponsibilitiesConduct 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 ...
New
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 ...
New
HopeLink. Internship Behavioral Health
Oakton, VA · On-site
$15.25 - $19.75/hr
The HopeLink Behavioral Health Internship Program is intended to provide Masters level students in clinical programs opportunities to obtain clinical experience and develop clinical skills in a ...
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HopeLink. Internship Behavioral Health
Oakton, VA · On-site
$15.25 - $19.75/hr
The HopeLink Behavioral Health Internship Program is intended to provide Masters level students in clinical programs opportunities to obtain clinical experience and develop clinical skills in a ...
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 ...
New
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 ...
New
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 ...
New
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 ...
New
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 ...
New
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 ...
New
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 ...
Utilization Specialist - Acute
Williamsburg, VA · On-site
$24 - $28/hr
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 - Acute
Williamsburg, VA · On-site
$24 - $28/hr
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 health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical ...
... behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical ...
... behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical ...
... behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical ...
... behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical ...
... behavioral health conditions, applying established clinical review criteria, guidelines and medical policies and contractual benefits as well as State and Federal Mandates. May perform clinical ...
Behavior HealthCare Coordinator
Richmond, VA · On-site +1
Sentara Health is looking to hire a Behavior Health Utilization Management Care Coordinator Standard working hours: 8am to 5pm EST, MF This position will work with members under Sentara Health Plans ...
Behavior HealthCare Coordinator
Richmond, VA · On-site +1
Sentara Health is looking to hire a Behavior Health Utilization Management Care Coordinator Standard working hours: 8am to 5pm EST, MF This position will work with members under Sentara Health Plans ...
Supervisor of Behavioral Health Therapy
Manassas, VA · On-site
$32.61 - $54/hr
Also responsible for directing the allied health professional teams that provide authorization of services, utilization review, and therapy services for Behavioral Health patients in Outpatient and ...
New
Supervisor of Behavioral Health Therapy
Manassas, VA · On-site
$32.61 - $54/hr
Also responsible for directing the allied health professional teams that provide authorization of services, utilization review, and therapy services for Behavioral Health patients in Outpatient and ...
New
Internship Behavioral Health Utilization Review information
What is the difference between Internship Behavioral Health Utilization Review vs Behavioral Health Case Manager?
| Aspect | Internship Behavioral Health Utilization Review | Behavioral Health Case Manager |
|---|---|---|
| Credentials | Typically in training, no required certifications | Often requires licensure or certification (e.g., LCSW, LPC) |
| Work Environment | Internship setting, supervised, often in healthcare or insurance companies | Clinical settings, community agencies, hospitals |
| Job Focus | Assisting with review of treatment plans, insurance authorization, and utilization data | Providing direct client support, care coordination, and treatment planning |
While Internship Behavioral Health Utilization Review involves supporting the review process and insurance authorization under supervision, Behavioral Health Case Managers focus on direct client care and coordination. Both roles are essential in mental health services but differ in responsibilities, experience requirements, and work settings.
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 cities in Virginia are hiring for Internship Behavioral Health Utilization Review jobs?
Cities in Virginia with the most Internship Behavioral Health Utilization Review job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 3 days ago
New
Sentara Health rating
6.7
Based on 413 frontline employees who took The Breakroom Quiz
532nd of 895 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.
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
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About Sentara Health
Sourced by ZipRecruiter
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Norfolk, VA, US
Year founded
1888