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Remote Bcba Autism Utilization Review Jobs in Virginia

Prestige

LPN Case Manager

Richmond, VA · Remote

$75K/yr

... utilization review * Facilitate timely and safe discharge planning * Serve as primary point of ... This is a Remote Position. * Competitive Salary * Medical, Dental, and Vision Insurance * 401K ...

Sentara Health

Benefits Coding Analyst

Richmond, VA · Remote

$10K/mo

This position is remote however, candidates must be able to commute to our Richmond location. The ... benefit and utilization review policies and criteria for emerging treatments, technology ...

McGuireWoods LLP

Director, Benefits

Richmond, VA · On-site +1

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

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Remote Bcba Autism Utilization Review information

What is the difference between Remote Bcba Autism Utilization Review vs Remote Bcba Autism Case Manager?

AspectRemote Bcba Autism Utilization ReviewRemote Bcba Autism Case Manager
CertificationsBCBA, Autism-specific trainingBCBA, Autism-specific training
Work EnvironmentReviewing medical and insurance documentation remotelyCoordinating care and services remotely
Employer & IndustryHealthcare, insurance companies, therapy providers

Both roles require BCBA certification and focus on autism services, but the Autism Utilization Review primarily involves evaluating insurance claims and authorizations, while the Autism Case Manager coordinates ongoing care and services for clients. Understanding these differences helps professionals choose the role that best fits their skills and career goals.

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Infographic showing various Remote Bcba Autism Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Remote Cardiology, Physician Clinical Reviewer

Evolent

Arlington, VA • On-site, Remote

Other

Re-posted 2 days ago

Evolent rating

8.4

Company rating: 8.4 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

73rd of 500 rated business services

Job description

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.



Collaboration Opportunities:  


  • Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers.



What You Will Be Doing:


  • Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.

  • Provides clinical rationale for standard and expedited appeals.

  • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.

  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.

  • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.

  • Participates in on-going training per inter-rater reliability process.

  • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.

  • On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.



Qualifications - Required and Preferred:


  • MD/DO/MBBS Degree

  • Current, unrestricted clinical license in medicine or required specialty

  • Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs

  • Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease

  • Strong clinical, management, communication, and organizational skills

  • Energetic and curious with a passion for quality and value in health care

  • Computer Proficiency

  • Minimum of five (5) years’ experience in the practice of Cardiology is preferred

  • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.

  • No history of a major disciplinary or legal action by a state medical board

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