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Remote Hca Utilization Review Jobs in Virginia (NOW HIRING)

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

... utilization review, or managed care experience; or any combination of education and experience ... Prefer candidates who hold an active compact license and reside in a compact state * 100% Remote ...

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

... utilization review, or managed care experience; or any combination of education and experience ... Prefer candidates who hold an active compact license and reside in a compact state * 100% Remote ...

FCCI Insurance Group

Medical Case Manager

Glen Allen, VA · On-site +1

$62K - $96K/yr

... s) through utilization of established guidelines to determine appropriate medical treatment ... to review and research conducted utilizing nationally accepted practice parameters. This position ...

State of Virginia

Case Intake Manager

Henrico, VA · Remote

$87K - $115K/yr

This sworn position ensures the timely and accurate review of allegations of misconduct through ... Must be willing to perform mobile work and to maintain a remote office with high speed Internet ...

SOSi

DoD SkillBridge Logistics Manager

Reston, VA · On-site +1

... utilization of logistics support services. Responsibilities: * Foster a team-oriented work ... Reviews and analyzes reports, such as revenue and performance records to recommended process ...

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All JobsHca Utilization Review JobsRemote Hca Utilization Review JobsRemote Hca Utilization Review Jobs in Virginia

Remote Hca Utilization Review information

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

AspectRemote Hca Utilization ReviewRemote Hca Case Manager
CredentialsTypically requires healthcare-related certifications, such as RN or licensed healthcare professionalOften requires RN, social work, or case management certifications
Work EnvironmentPrimarily reviewing medical necessity and insurance coverage remotelyManaging patient cases, coordinating care, and discharge planning remotely
Employer & Industry UsageUsed by health insurance companies, healthcare providers, and utilization review organizationsEmployed by hospitals, insurance companies, and healthcare organizations

Remote Hca Utilization Review focuses on assessing medical necessity and insurance coverage, while Remote Hca Case Managers handle patient care coordination and discharge planning. Both roles require healthcare credentials and are integral to healthcare management, but they differ in daily responsibilities and focus areas.

How do I get into a remote HCA utilization review?

To become a remote HCA utilization review specialist, candidates typically need a healthcare background such as nursing or medical coding, along with knowledge of insurance policies and medical terminology. Relevant certifications like Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can improve job prospects. Employers often require prior experience in medical review or utilization management and proficiency with electronic health record (EHR) systems, with many roles offering flexible or remote schedules.

Is remote HCA utilization review work from home?

Remote HCA utilization review jobs are often performed from home, allowing reviewers to assess healthcare claims and authorizations remotely. These roles typically require familiarity with healthcare software, strong communication skills, and adherence to confidentiality standards. Many employers offer flexible or fully remote schedules for this position.

What are popular job titles related to Remote Hca Utilization Review jobs in Virginia?

For Remote Hca Utilization Review jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Remote Hca Utilization Review jobs in Virginia look for?

The top searched job categories for Remote Hca Utilization Review jobs in Virginia are:

What cities in Virginia are hiring for Remote Hca Utilization Review jobs?

Cities in Virginia with the most Remote Hca Utilization Review job openings:

Remote Hca Utilization Review jobs near you
Infographic showing various Remote Hca Utilization Review job openings in Virginia as of July 2026, with employment types broken down into 90% Full Time, and 10% Contract. Highlights an 100% Remote job distribution.

BCBA - Hybrid Clinical & Operations Supervisor (Remote)

Civitas Health Services

Sandston, VA • On-site, Remote

$72K - $88K/yr

Full-time

Posted 3 days ago

New

Job description

Overview

Civitas Health Services is restructuring its ABA program across the Richmond Metro and Hampton Roads regions with one goal: to build the best ABA program in the country - an evidence-based practice driven by data collection, graphed and charted outcomes, ISP-driven planning, and regulatory compliance followed to the letter. We are hiring a BCBA who is equal parts clinician and program builder to help lead that transformation.

About the Role

This is not a standard BCBA position. You will carry a reduced service-hour expectation specifically so you can design, deploy, and run the operational backbone of our ABA program. You will work hand-in-hand with our Healthcare Administrator in weekly coordination meetings, tracking program metrics, utilization, and initiatives - and turning what the data says into action plans.

Remote (Virginia): Part-Time/Full Time

BCBA Salary Range:$96,000 - $118,000 commensurate with experience

Bonus Incentive Program:

  • You will be enrolled in our monthly performance-based incentive program, MAP (Motivation, Ambition, Progress). This point-based program allows you to earn up to $10,000 annually in bonuses, in addition to your base salary.

Qualifications (Minimum): BCBA /LBA Licensed by the State of Virginia Department of Health Professions Board of Medicine

What You Will Own

  • RBT supervision, training & credentialing program (strategic mandate). Build and run our internal pipeline end-to-end: structured supervision toward RBT certification (including candidates hired before certification), certification maintenance and renewal tracking, and an ongoing training curriculum in documentation standards, treatment fidelity, and ethics.
  • Program development & implementation. Design and deploy clinical programming and monitor overall program function across both regions.
  • Operations & administrative coordination. Partner with the Healthcare Administrator on program oversight, group scheduling, vendor and third-party collaborator management, and weekly metrics-driven coordination meetings.
  • Clinical service delivery. Maintain a partial caseload with your own billing; assist with initial assessments and reassessments, monthly and quarterly ISP reviews, and weekly care coordination and outreach.
  • Quality & compliance. Help ensure services align with Virginia DMAS/Medicaid regulations, the BACB Ethics Code, and Joint Commission accreditation standards, with outcomes demonstrated through graphs and charts at every ISP touchpoint.

What You Bring

  • Board Certified Behavior Analyst (BCBA) in good standing; licensed or license-eligible as an LBA in Virginia.
  • Demonstrated strength in program operations, program development, or clinical systems - you have built processes, not just followed them.
  • Experience supervising RBTs and supporting technicians through certification (RBT supervision program experience strongly preferred).
  • Fluency in data: collection systems, aggregation, analysis, and visual presentation of client outcomes.
  • Working knowledge of Virginia DMAS/Medicaid ABA requirements and utilization standards; Joint Commission experience a plus.
  • Exceptional organization and communication; comfortable co-owning program operations with administrative leadership.

What We Offer

  • A rare hybrid clinical/operations seat with real authority to design and build.
  • Reduced billable-hour expectation (~20 hrs/week) to protect your program-building time.
  • Remote work within Virginia, supporting our Richmond Metro and Hampton Roads teams.
  • A leadership team committed to an evidence-based, data-driven, fully compliant model - and to being the best in the country.

Civitas Health Services, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

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