Richmond, VA · Remote
$75K/yr
Medical
Dental
Vision
Retirement
PTO
... 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 ...
Quick apply
Richmond, VA · Remote
$75K/yr
Medical
Dental
Vision
Retirement
PTO
... 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 ...
Richmond, VA · Remote
Medical
Retirement
... remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred ... LICENSES AND CERTIFICATIONS Nursing/Registered Nurse (RN) is required, active and unrestricted for ...
Richmond, VA · Remote
Medical
Retirement
... remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred ... LICENSES AND CERTIFICATIONS Nursing/Registered Nurse (RN) is required, active and unrestricted for ...
VA · On-site +1
Medical
Life
Retirement
PTO
This is a remote opportunity. The Consultant will review WCMSA case submissions in support of the ... Preferred Skills and Qualifications: - Bachelor's degree from an accredited institution in Nursing ...
VA · On-site +1
Medical
Life
Retirement
PTO
This is a remote opportunity. The Consultant will review WCMSA case submissions in support of the ... Preferred Skills and Qualifications: - Bachelor's degree from an accredited institution in Nursing ...
Richmond, VA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
... 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 ...
Richmond, VA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
... 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 ...
Richmond, VA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
... 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 ...
Richmond, VA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
... 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 ...
Norfolk, VA · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
... LMFT/RN - Remote in VA and NC! Status: Full-time, permanent position (40 hours) Work hours ... Behavioral Health Utilization Management clinician is responsible for review of clinical ...
Norfolk, VA · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
... LMFT/RN - Remote in VA and NC! Status: Full-time, permanent position (40 hours) Work hours ... Behavioral Health Utilization Management clinician is responsible for review of clinical ...
Arlington, VA · On-site +1
$100K - $120K/yr
Medical
Our entire team is remote across the United States, from the West Coast to the East Coast. There ... Contribute to the next version of the program's drug utilization review tools * Help lead the team ...
Arlington, VA · On-site +1
$100K - $120K/yr
Medical
Our entire team is remote across the United States, from the West Coast to the East Coast. There ... Contribute to the next version of the program's drug utilization review tools * Help lead the team ...
Woodbridge, VA · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
This position requires both in-person/face-to-face assessments and remote telephonic assessments ... Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals ...
Woodbridge, VA · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
This position requires both in-person/face-to-face assessments and remote telephonic assessments ... Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals ...
Manassas, VA · On-site +1
$250K - $350K/yr
... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...
Manassas, VA · On-site +1
$250K - $350K/yr
... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...
Manassas, VA · Remote
$250K - $350K/yr
... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...
Manassas, VA · Remote
$250K - $350K/yr
... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...
Manassas, VA · Remote
$250K - $350K/yr
... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...
Manassas, VA · Remote
$250K - $350K/yr
... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Roanoke, VA · On-site +1
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Roanoke, VA · On-site +1
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Roanoke, VA · On-site +1
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Roanoke, VA · On-site +1
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Fully Remote: Candidates may work remotely from anywhere within the United States. Hybrid ... utilization. * Collaborate with physicians through electronic communication, face-to-face meetings ...
Norfolk, VA · On-site +1
$29.25 - $38.75/hr
Medical
Dental
Vision
Life
Retirement
PTO
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 ...
Norfolk, VA · On-site +1
$29.25 - $38.75/hr
Medical
Dental
Vision
Life
Retirement
PTO
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 ...
Richmond, VA · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
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 ...
Richmond, VA · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
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 ...
Chesapeake, VA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Work Environment This position is fully remote, allowing for flexibility and the ability to work ... Engaging with insurance companies for pre-certification processes and managing utilization review ...
Posted today
Chesapeake, VA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Work Environment This position is fully remote, allowing for flexibility and the ability to work ... Engaging with insurance companies for pre-certification processes and managing utilization review ...
Posted today
Nurse Practitioner (Remote) - Transportation Security This Position Is Contingent Upon Bid Award ... The Nurse Practitioner will perform advanced clinical review of employee medical records, including ...
Quick apply
Nurse Practitioner (Remote) - Transportation Security This Position Is Contingent Upon Bid Award ... The Nurse Practitioner will perform advanced clinical review of employee medical records, including ...
The RN Triage and Transition is a remote position; however the caregiver must reside in Colorado or ... Conducts root cause analysis of extended post-acute stays, inappropriate utilization, readmissions ...
New
The RN Triage and Transition is a remote position; however the caregiver must reside in Colorado or ... Conducts root cause analysis of extended post-acute stays, inappropriate utilization, readmissions ...
New
$21.21 - $25.50
2% of jobs
$25.50 - $29.79
9% of jobs
$32.73 is the 25th percentile. Wages below this are outliers.
$29.79 - $34.08
21% of jobs
The median wage is $37.55 / hr.
$34.08 - $38.37
23% of jobs
$38.37 - $42.66
13% of jobs
$46 is the 75th percentile. Wages above this are outliers.
$42.66 - $46.95
10% of jobs
$46.95 - $51.24
8% of jobs
$51.24 - $55.53
5% of jobs
$55.53 - $59.82
5% of jobs
$59.82 - $64.11
2% of jobs
$64.11 - $68.40
2% of jobs
$21
$41
$68
As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.
| Aspect | Remote Utilization Review Nurse | Remote Case Manager |
|---|---|---|
| Certifications | RN license, possibly CCM or UR certifications | RN license, CCM or case management certifications |
| Work Environment | Healthcare facilities, insurance companies, telehealth | Insurance companies, healthcare organizations, telehealth |
| Job Focus | Review medical necessity, approve or deny services | Coordinate patient care, arrange services, discharge planning |
Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.
The most popular types of Utilization Review Nurse jobs in Virginia are:
For Remote Utilization Review Nurse jobs in Virginia, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review Nurse jobs in Virginia are:
Cities in Virginia with the most Remote Utilization Review Nurse job openings:
$75K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 21 days ago
Case Manager
At Prestige Healthcare Services, we are committed to delivering exceptional care and support to our patients and their families. Our skilled facilities offer a range of short-term and long-term skilled rehabilitation services to meet the diverse needs of our patients. We are seeking a dedicated and compassionate Case Manager to join our team.
Responsibilities:
• Develop, implement, and monitor individualized care plans in collaboration with the interdisciplinary team (nursing, therapy, social services, dietary)
• Coordinate and communicate with insurance companies and managed care organizations to obtain authorizations and manage utilization review
• Facilitate timely and safe discharge planning
• Serve as primary point of contact for residents and families regarding care plans, insurance coverage, and discharge options
• Monitor length of stay and levels of care to ensure appropriate resource utilization
• Maintain accurate and timely documentation in the electronic health record (EHR) in compliance with state and federal regulations
• Ensure compliance with CMS, state survey, and facility policies related to case management and discharge planning
• Collaborate with admissions to review referrals and support smooth transitions into the facility
What We Offer:
This is a Remote Position.
Competitive Salary
Medical, Dental, and Vision Insurance
401K Retirement Plan
Paid Time Off (PTO) and Sick Time in accordance with VA Law
Employee Wellness Program
Flexible Spending Account
Employee Assistance Program
Daily Pay
Requirements
LPN in the state of Virginia
Experience in managed care/HMOS and skilled nursing admission and/or admissions coordination.
If you are a motivated and compassionate healthcare professional looking for a new challenge, we encourage you to apply for this exciting opportunity.
To learn more about this role and how you can make a difference at Prestige Healthcare Services, please apply today!
Prestige Healthcare Services is an equal opportunity employer.
Sourced by ZipRecruiter
Sporting product manufacturing
51 - 200 Employees
San Diego, CA, US
1991
