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Pediatric Utilization Management Jobs in Virginia

Physician Advisor (Remote)

Manassas, VA · Remote

$250K - $350K/yr

Board Certified in Family Medicine, Internal Medicine or Pediatrics * Eligible for Virginia medical licensure * Prior Utilization Management experience preferred * Knowledge of CMS regulations and ...

... hour pediatric and adult emergency care, the only Level 3 Trauma Center in Loudoun County ... Uses utilization management techniques to determine the medical necessity, appropriateness and ...

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Pediatric Utilization Management information

What is pediatric utilization management?

Pediatric Utilization Management (UM) is a healthcare process that reviews and evaluates the medical necessity, efficiency, and appropriateness of healthcare services provided to children. Professionals in this field assess treatment plans, hospital stays, procedures, and medications to ensure they align with evidence-based guidelines and are truly needed for a pediatric patient's care. The goal is to optimize health outcomes for children while managing healthcare costs and resources efficiently. Pediatric UM often involves collaboration between healthcare providers, insurance companies, and families to make informed decisions about a child's medical care.

What are some common challenges faced by professionals in pediatric utilization management, and how can they be addressed?

Professionals in Pediatric Utilization Management often encounter challenges such as balancing cost-effective care with the unique needs of pediatric patients, staying updated with evolving clinical guidelines, and communicating effectively with both providers and families. Navigating insurance requirements while advocating for appropriate treatments requires strong clinical knowledge and negotiation skills. Building collaborative relationships with multidisciplinary teams and ongoing professional development can help address these challenges and ensure the best outcomes for young patients.

What are the key skills and qualifications needed to thrive as a pediatric utilization management nurse, and why are they important?

To thrive in Pediatric Utilization Management, you need a solid background in pediatric nursing, critical thinking, and knowledge of healthcare regulations, generally supported by an RN license and experience in pediatrics. Familiarity with utilization review software, electronic medical records (EMRs), and certification such as Certified Case Manager (CCM) or Utilization Review Accreditation Commission (URAC) is often required. Excellent communication, attention to detail, and strong organizational skills are crucial for collaborating with medical teams and advocating for appropriate patient care. These competencies ensure effective care coordination, regulatory compliance, and optimal outcomes for pediatric patients.

What is the difference between Pediatric Utilization Management vs Pediatric Case Management?

AspectPediatric Utilization ManagementPediatric Case Management
CredentialsRN, licensed healthcare professionals, certifications in utilization reviewRN, social worker, case management certification
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, community health settings
Employer & Industry UsageInsurance providers, managed care organizationsHospitals, outpatient clinics, social services
FocusReviewing medical necessity, approving services, optimizing resource useCoordinating care, supporting patient needs, discharge planning

While both roles involve working with pediatric patients, Pediatric Utilization Management primarily focuses on reviewing and approving healthcare services for medical necessity within insurance or managed care settings. Pediatric Case Management emphasizes coordinating ongoing patient care and support services across healthcare providers and community resources.

What are popular job titles related to Pediatric Utilization Management jobs in Virginia?

For Pediatric Utilization Management jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Pediatric Utilization Management jobs in Virginia look for?

The top searched job categories for Pediatric Utilization Management jobs in Virginia are:

What cities in Virginia are hiring for Pediatric Utilization Management jobs?

Cities in Virginia with the most Pediatric Utilization Management job openings:

Infographic showing various Pediatric Utilization Management job openings in Virginia as of August 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 83% In-person, and 17% Remote job distribution.

Pediatric Pathologist (MD/DO) (Full-time or PRN)

Inova Health System

Falls Church, VA • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 23 days ago


Inova Health System rating

7.5

Company rating: 7.5 out of 10

Based on 260 frontline employees who took The Breakroom Quiz

239th of 891 rated healthcare providers


Job description

Job Description

Inova Laboratories, located in Northern Virginia, is seeking an experienced pathologist with board certification in clinical pathology to serve as part of the clinical pathology service of this large and expanding system laboratory. Fellowship training in Pediatric Pathology is required and at least 3-5 years of experience is ideal. Candidates must be certified in Anatomic and Clinical Pathology by the American Board of Pathology or equivalent and be eligible for certification in Pediatric Pathology or have equivalent training/experience. Candidates must also be eligible for medical licensure in Virginia. The preferred applicant should have experience in providing clinical pathology services and is expected to sign out clinical pathology and surgical/hematopathology (as appropriate) cases for both adult and pediatrics.

The position will be actively involved in clinical issues, such as, consultation for clinician inquiry, quality management, operational efficiency including utilization management and outreach and work with laboratory Medical Director, administration and technical personnel to ensure that world-class diagnostic services are provided. The ability to assist in leading a highly proficient team and excellent interpersonal skills are desired.

Inova Health Pathology Department currently supports 5 hospitals and numerous outpatient surgery centers and clinics and is currently comprised of 48 credentialed pathologists.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Pathologist Job Responsibilities:

  • As a Clinical Pathologist, responsibilities would include help with Laboratory regulatory compliance, validations, process improvements, and quality initiatives along with participation in the appropriate intra- and extradepartmental committees as a section medical director.
  • Pathologist should possess strong overall diagnostic and communicative skills with the ability to handle clinical and surgical (if appropriate) pathology sign out of an active pathology service (Peripheral smears, electrophoresis, body fluids, etc.) and have interest and ability in overseeing daily clinical laboratory duties, such as apheresis, blood bank, hematology, and chemistry.
  • Pathologists can participate in centralized slide distribution and evenly share cases across the system which enables subspecialty sign out of cases within the pathologist's preferred subspecialties if applicable (Hematopathology, etc.).
  • On-call duties include blood bank calls, apheresis and other consults from the clinical laboratory.
  • Education: Graduate of accredited Medical Doctorate Program (MD/DO)

Requirements:

  • Board Certification: Anatomic and Clinical Pathology - AP/CP
  • Fellowship training: Pediatrics
  • Certification: Must obtain advanced certification in applicable modality within one year of training; BLS from the American Heart Association
  • Licensure: Currently hold or ability to obtain an unrestricted VA medical licensure
  • Credentialing: Ability to obtain successful medical staff credentials throughout all of our Inova pathology locations

Preferred Qualifications:

  • 3-5 years of previous experience in pediatrics

Featured Benefits:

  • Physician Led Organization
  • Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
  • Competitive Compensation Package: Competitive Base and Incentive program, opportunities for Sign On/Retention/Relocation
  • Retirement: Inova matches the first 5% of eligible contributions – starting on your first day. 457B retirement plan is also available for physicians in a 0.5 FTE and greater
  • CME Support: Up to $3,500 a year for CME support and up to 5 days of CME
  • Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
  • Work/Life Balance: offering paid time off, paid parental leave

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