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Remote Case Reviewer Jobs in Virginia (NOW HIRING)

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Beacon Talent

Remote Psychiatrist

Lexington, VA · Remote

$150 - $200/hr

Document within our behavioral health EMR to the standard required for payer review * Escalate ... Full admissions and assessment support on every case * Average of [XX] encounters per shift, with ...

Beacon Talent

Remote Psychiatrist

Cumberland, VA · Remote

$150 - $200/hr

Document within our behavioral health EMR to the standard required for payer review * Escalate ... Full admissions and assessment support on every case * Average of [XX] encounters per shift, with ...

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All JobsCase Reviewer JobsRemote Case Reviewer JobsRemote Case Reviewer Jobs in Virginia

Remote Case Reviewer information

What is a remote case reviewer?

Remote case reviewers are professionals who assess and evaluate cases, such as medical, legal, or insurance files, from a remote location rather than working on-site. Their responsibilities typically include reviewing documentation, ensuring compliance with policies and regulations, and providing recommendations or decisions based on their findings. Remote case reviewers use secure digital platforms to access and analyze case materials, enabling flexibility and efficiency in their work. This role can be found in industries like healthcare, law, insurance, and finance. Strong attention to detail and analytical skills are essential for success in this position.

What are the key skills and qualifications needed to thrive as a remote case reviewer?

To thrive as a Remote Case Reviewer, you need strong analytical skills, attention to detail, and relevant professional credentials, often in fields like healthcare, insurance, or law. Familiarity with case management software, electronic documentation systems, and industry regulations (such as HIPAA for healthcare) is typically required. Excellent written communication, time management, and independent decision-making are standout soft skills for this role. These abilities ensure accurate, compliant, and efficient case evaluations while maintaining high-quality standards in a remote work environment.

What are some common challenges remote case reviewers face, and how can they effectively manage them?

Remote Case Reviewers often encounter challenges such as managing a high volume of cases, staying organized with digital documentation, and maintaining clear communication with team members across different locations. To address these, it's important to develop strong time management skills, utilize standardized review checklists, and take advantage of collaboration tools like secure messaging platforms. Regular virtual meetings and clear protocols help ensure consistency and quality, while ongoing training can keep reviewers up to date on best practices.

What is the difference between Remote Case Reviewer vs Remote Claims Processor?

AspectRemote Case ReviewerRemote Claims Processor
Required CredentialsHigh school diploma or equivalent; healthcare or legal background often preferredHigh school diploma or equivalent; experience in insurance or claims processing beneficial
Work EnvironmentHome-based, independent review settingHome-based, processing insurance claims
Industry UsageHealthcare, legal, insurance sectorsInsurance companies, third-party administrators
Common Search/ComparisonRemote Case Reviewer vs Remote Claims Processor

While both roles are remote and involve handling cases or claims, Remote Case Reviewers primarily evaluate and assess cases, often requiring specialized knowledge in healthcare or legal fields. Remote Claims Processors focus on processing insurance claims, verifying information, and ensuring accurate payment. Understanding these differences helps job seekers identify the role that best matches their skills and career goals.

What are popular job titles related to Remote Case Reviewer jobs in Virginia?

For Remote Case Reviewer jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Remote Case Reviewer jobs in Virginia look for?

The top searched job categories for Remote Case Reviewer jobs in Virginia are:

What cities in Virginia are hiring for Remote Case Reviewer jobs?

Cities in Virginia with the most Remote Case Reviewer job openings:

Remote Case Reviewer jobs near you
Infographic showing various Remote Case Reviewer job openings in Virginia as of August 2026, with employment types broken down into 42% Full Time, 43% Part Time, and 15% Contract. Highlights an 100% Remote job distribution.

UTILIZATION REVIEW NURSE

Norfolk, VA • On-site, Remote

Sentara Healthcare
Hospitals • 10K+ employees
Learn more about Sentara Healthcareexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 20 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

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.

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