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Kaiser Utilization Management Jobs in Virginia (NOW HIRING)

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Kaiser Utilization Management information

What is the difference between Kaiser Utilization Management vs Kaiser Case Manager?

AspectKaiser Utilization ManagementKaiser Case Manager
Primary RoleReview and authorize healthcare services based on medical necessityCoordinate and manage patient care plans and services
CertificationsTypically requires medical or nursing credentials, possibly certifications in utilization reviewOften requires nursing or social work credentials, with case management certifications
Work EnvironmentUtilization review departments within health plans or hospitalsDirect patient interaction, care coordination teams, healthcare facilities
Industry UsageCommonly employed by health insurance providers like KaiserEmployed in healthcare settings, insurance companies, or integrated health systems

While both roles are integral to healthcare management at Kaiser, Utilization Management focuses on reviewing services for appropriateness, whereas Case Managers actively coordinate patient care and services. Understanding these differences helps clarify career paths and job expectations within Kaiser’s healthcare system.

What is Kaiser Utilization Management?

Kaiser Utilization Management refers to the process within Kaiser Permanente that evaluates the necessity, appropriateness, and efficiency of healthcare services provided to members. Utilization management professionals review medical cases to ensure that treatments and procedures are medically necessary and align with established guidelines. Their goal is to optimize healthcare outcomes while controlling costs and preventing unnecessary services, ensuring members receive the right care at the right time.

How does a Kaiser Utilization Management professional typically collaborate with healthcare providers to ensure appropriate patient care?

Kaiser Utilization Management professionals work closely with physicians, nurses, and other healthcare team members to review patient cases and ensure that treatments and services are medically necessary and align with organizational guidelines. This collaboration often involves case discussions, care planning meetings, and providing recommendations for alternative care options when appropriate. Open communication and a collaborative approach help ensure patients receive high-quality care while also managing resources efficiently. Professionals in this role regularly interact with both clinical and administrative staff to resolve issues and support optimal patient outcomes.

What are the key skills and qualifications needed to thrive as a Kaiser Utilization Management professional?

To thrive in Kaiser Utilization Management, you need a solid background in clinical healthcare (often as an RN or other licensed clinician), understanding of medical necessity criteria, and experience with healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of guidelines such as Milliman or InterQual are typically required. Excellent communication, critical thinking, and organizational skills set standout professionals apart in this role. These competencies ensure effective resource management, regulatory compliance, and quality patient care within the healthcare system.
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Kaiser Utilization Management jobs near you
Infographic showing various Kaiser Utilization Management job openings in Virginia as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% In-person job distribution.

LMSW Case Manager, Social Work- In Patient II Arlington, VA Virginia Hospital (40hrs.)

Kaiser Permanente

Arlington, VA • On-site

$42.20/hr

Full-time

Medical, Life

Posted 15 days ago

Job description

This role is eligible for $7,500 sigin on bonus.
Job Summary:

For members of a defined population, responsible for collaborating with the members of the health care team to facilitate the coordination of appropriate, cost-effective services that are consistent with members plan of care, help achieve his/her optimal level of independence, and enhance quality of life.


Essential Responsibilities:
  • Responsibilities include, but are not limited to, problem identification, psychosocial assessment, financial counseling/referral, accessing community resources, placement for care, guiding the member through health-related legal processes, or consultation and support to other health care professionals.
  • Effectively manages and coordinates assigned caseload consistent with established criteria. Completes comprehensive psychosocial assessment to evaluate patient goals, social support systems, resources, health status, functional limitations, psychological status, environmental factors, and response to treatment so as to decrease inappropriate utilization of medical services.
  • In close collaboration with the nurse case manager and other members of the health care team, develops and monitors a plan of care designed to promote the members optimal level of functioning and enhance the quality of life.
  • Identifies, facilitates, and advocates appropriate organizational and community resources to meet the plan of care and ensures that they are implemented for in a cost effective, efficient, and timely manner.
  • Ensures consistent and reliable documentation of case management activities in compliance with all organization and department standards.
  • Analyzes patient and program outcomes to identify improvements in program, quality, and cost effectiveness of case management activities.
  • Facilitates application process for accessing local, state, and federally funded programs (e.g., Medicaid, Medicare, and Disability) and/or refers to appropriate community agencies in cases of suspected patient abuse/neglect when identified.
  • Provides supportive counseling and education to members, families and caregivers, members of the health care team, health plan staff, and the community, including end-of-life issues and Advanced Directives.
  • Promotes self-awareness and knowledge of current case management standards in the community and recent innovations in patient care. Maintains current knowledge of laws, regulations, and policies relating to the practice of social work in the local market/local agencies and maintains high social work standards as defined by the NASW Code of Ethics.
  • Scheduling and coordinating family meetings as needed.
  • Completing guardianship paperwork and providing technology assistance so that patients/family can virtually attend court proceedings, as needed.
  • INPATIENT ONLY - Completion of Uniform Assessment Instruments (UAIS) form for long-term care (Virginia Medicaid requirement only).
  • Performs other related duties as assigned.

Wk 1: Su, M, W, Th, F  Wk 2: M, Tu, W, Th, Sa
 
Basic Qualifications:
Experience
  • Minimum one (1) years of clinical social work experience in a health care setting required.
Education
  • Masters degree in social work (MSW) required.
License, Certification, Registration

  • This job requires credentials from multiple states. Credentials from the primary work state are required at hire. Additional Credentials from the secondary work state(s) are required post hire.
     

  • Licensed Independent Social Worker (District of Columbia) within 6 months of hire OR Licensed Graduate Social Worker (District of Columbia) within 6 months of hire 
     

  • Licensed Master Social Worker (Maryland) within 6 months of hire
     

  • Licensed Master's Social Worker (Virginia) within 6 months of hire
     
Additional Requirements:
  • N/A
Preferred Qualifications:
  • Experience with computer software programs in a Windows environment preferred.
  • Knowledge of community systems and resources in the defined service area preferred.
  • Knowledge of regulatory issues for the Mid-Atlantic area preferred.

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