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Peer Review Manager Jobs in Virginia (NOW HIRING)

ICF

Title IV-E Peer Reviewers

Reston, VA

Assisting CB in conducting a Title IV-E Review by: * Working alone or with a state reviewer ... Supervisory, administrative, and/or management experience in a public (federal, state, or local) or ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Facilitates peer review calls between facility and external organizations. Identifies potential ...

Dane Street

Board-Certified Pulmonology

Chesterfield, VA · On-site

$305K - $406K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

Dane Street

Board-Certified Pulmonologist

Richmond, VA · On-site

$296K - $395K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

Dane Street, LLC

Board-Certified Pulmonology

Chesterfield, VA · On-site

$285K - $380K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

Dane Street, LLC

Board-Certified Pulmonologist

Richmond, VA · On-site

$296K - $395K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

Dane Street, LLC

Board-Certified Pulmonologist

Richmond, VA · On-site

$296K - $395K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

Dane Street

Board-Certified Pulmonology

Richmond, VA · On-site

$296K - $395K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Facilitates peer review calls between facility and external organizations. Identifies potential ...

Dane Street, LLC

Board-Certified Pulmonologist

Richmond, VA · On-site

$296K - $395K/yr

Dane Street is a national leader in Independent Medical Examinations (IMEs) and peer review ... Respond to clinical queries to support claims management * Deliver detailed IME reports within an ...

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All JobsPeer Review JobsPeer Review Manager JobsPeer Review Manager Jobs in Virginia

Peer Review Manager information

How does a peer review manager typically interact with authors, reviewers, and editorial boards during the publication process?

A Peer Review Manager acts as the central point of communication among authors, reviewers, and the editorial board. They coordinate reviewer assignments, ensure timely responses, and help resolve conflicts or delays. The role requires diplomacy and strong organizational skills, as managers must balance the needs of authors seeking feedback, reviewers' workloads, and editorial standards. Regular updates and clear communication are essential to keep the review process transparent and efficient.

What are the key skills and qualifications needed to thrive as a peer review manager?

A Peer Review Manager typically needs a background in academic publishing or scholarly communications, with strong organizational skills and familiarity with editorial workflows. Proficiency with manuscript management systems (such as Editorial Manager or ScholarOne) and knowledge of peer review best practices are essential, and certifications in project management can be advantageous. Excellent communication, problem-solving, and stakeholder management skills help foster effective collaboration between authors, reviewers, and editors. These competencies are crucial for ensuring an efficient, fair, and high-quality peer review process that upholds the integrity of scholarly publications.

What is a peer review manager?

Peer Review Managers are professionals responsible for overseeing the peer review process of academic journals, conferences, or research publications. They coordinate manuscript submissions, assign reviewers, manage communications between authors and reviewers, and ensure the integrity and timeliness of the review process. Their goal is to maintain high standards of quality and transparency in scholarly publishing. Peer Review Managers often work closely with editors and publishers to implement editorial policies and resolve any conflicts or ethical issues that may arise.
What are the most commonly searched types of Peer Review jobs in Virginia? The most popular types of Peer Review jobs in Virginia are:
What are popular job titles related to Peer Review Manager jobs in Virginia? For Peer Review Manager jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Peer Review Manager jobs in Virginia look for? The top searched job categories for Peer Review Manager jobs in Virginia are:
What cities in Virginia are hiring for Peer Review Manager jobs? Cities in Virginia with the most Peer Review Manager job openings:
Peer Review Manager jobs near you

Clinical Authorization Specialist (Utilization Review)

HALLMARK YOUTHCARE RICHMOND INC

Richmond, VA • On-site

Other

Medical, Retirement

Posted 24 days ago

Job description

As a leading Residential Treatment Center in the Greater Richmond area, Hallmark Youthcare treats adolescents with emotional and behavioral challenges triggered by trauma. Treatment is provided in a warm and friendly environment by a group of well-trained, highly motivated staff that take pride in delivering quality care in a fast-paced environment.

We are seeking a detail-oriented Clinical Authorization Specialist (Utilization Review) to join our healthcare team. The ideal candidate will have experience in prior authorizations, insurance verification, utilization review, and medical necessity determinations. This role is responsible for ensuring that medical services are appropriately authorized, clinically supported, and compliant with payer guidelines before, during, and after patient care.

The Clinical Authorization Specialist serves as a liaison between healthcare providers, insurance companies, and patients to facilitate timely approvals while minimizing denials and delays in care.

In addition, this role maintains communication with referral sources (CSA/FAPT/IACCT) to coordinate placement and reimbursement standards for transfers from emergency placements and document submission to Magellan for Medicaid consideration.  

Key Responsibilities
  • Master's degree in health services field.
  • Review and process prior authorization requests for medical procedures, diagnostic testing, medications, therapies, and specialty services.
  • Evaluate clinical documentation to determine medical necessity using payer guidelines, evidence-based criteria, and insurance policies.
  • Perform prospective, concurrent, and retrospective utilization reviews.
  • Communicate with physicians, nurses, case managers, and insurance representatives to obtain required clinical documentation.
  • Submit authorization requests and monitor status through payer portals and electronic health record (EHR/EMR) systems.
  • Track authorization approvals, denials, appeals, and expiration dates to ensure continuity of care.
  • Identify incomplete or missing documentation and coordinate with providers to obtain necessary information.
  • Maintain accurate records of all authorization activities, communications, and determinations.
  • Stay current on payer policies, CMS regulations, and utilization management best practices.
  • Assist with appeals and peer-to-peer review coordination when necessary.
  • Meet productivity, turnaround time, quality, and compliance standards.

Required Qualifications

  • High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
  • Minimum of 2 years of experience in prior authorization, utilization review, medical insurance, case management, including admissions.
  • Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Experience working with electronic medical records (EMR/EHR) and payer authorization portals.
  • Excellent organizational, analytical, and problem-solving skills.
  • Strong verbal and written communication abilities.
  • Ability to prioritize multiple tasks in a fast-paced healthcare environment.

Benefits:

Set schedule Monday- Friday 9 am- 5pm

Full benefit package available

Matching 401K 

Time off accrued each payroll

Free employee meals

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