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Remote Utilization Review Social Worker Jobs in Ohio

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Remote Utilization Review Social Worker information

What does a remote utilization review social worker do?

A Remote Utilization Review Social Worker evaluates patient care plans and medical records to ensure that healthcare services are medically necessary, appropriate, and cost-effective. Working remotely, they collaborate with healthcare providers, insurance companies, and patients to review treatment plans and make recommendations on care approvals or alternatives. Their goal is to help manage healthcare costs while ensuring patients receive the care they need, often working within hospitals, insurance companies, or third-party review organizations.

What are the key skills and qualifications needed to thrive as a remote utilization review social worker?

To thrive as a Remote Utilization Review Social Worker, you need a background in social work (often a MSW and relevant licensure), knowledge of medical terminology, and experience in patient care coordination. Familiarity with utilization management software, electronic health records (EHRs), and certification such as ACM or CCM is typically required. Strong analytical thinking, communication skills, and the ability to work independently are vital soft skills for this position. These skills ensure effective patient advocacy, compliance with regulations, and optimal resource utilization in a remote healthcare environment.

How does a remote utilization review social worker typically collaborate with interdisciplinary teams while working off-site?

Remote Utilization Review Social Workers regularly communicate with physicians, nurses, case managers, and insurance representatives through virtual meetings, secure emails, and electronic health record systems. Despite working remotely, they play a key role in ensuring appropriate patient care by reviewing cases, discussing treatment plans, and advocating for necessary services. Collaboration often involves scheduled case conferences and prompt responses to queries, requiring strong organizational and digital communication skills. Building effective working relationships remotely is crucial for delivering coordinated, patient-centered care.

What are the most commonly searched types of Utilization Review Social Worker jobs in Ohio?

The most popular types of Utilization Review Social Worker jobs in Ohio are:

What job categories do people searching Remote Utilization Review Social Worker jobs in Ohio look for?

The top searched job categories for Remote Utilization Review Social Worker jobs in Ohio are:

What cities in Ohio are hiring for Remote Utilization Review Social Worker jobs?

Cities in Ohio with the most Remote Utilization Review Social Worker job openings:

Infographic showing various Remote Utilization Review Social Worker job openings in Ohio as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Social Worker - Behavioral Health Interdisciplinary Program (BHIP)

Veterans Health Administration

East Liverpool, OH • On-site

$75K - $118K/yr

Full-time

PTO

This job post has expired 3 days ago. Applications are no longer accepted.


Veterans Health Administration rating

8.1

Company rating: 8.1 out of 10

Based on 1,007 frontline employees who took The Breakroom Quiz

68th of 898 rated healthcare providers


Job description

Summary
This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) and eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application.
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Duties
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VA Careers - Social Work: https://youtube.com/embed/enRhz_ua_UU
The VA Northeast Ohio Healthcare System is recruiting for an Social Worker serves as a BHIP Care Coordinator. The Social Worker will function in Social Work Service. The Position duties include, but are not limited to:
  • Coordinates care including serving as an advocate on behalf of the Veterans on BHIP teams to ensure delivery of comprehensive seamless mental health service.
  • Determining and monitoring care coordination needs over time, providing care coordination, and facilitating follow-up and outreach as needed to promote proactive, personalized care and care continuity.
  • Following national guidance and local policy and SOPs for mental health services. This includes following policies, and documentation requirements as required for CARF and The Joint Commission accreditation as well as other internal and external requirements.
  • Participates in program planning and development, advising the supervisor of shifting trends with care coordination needs and caseloads and identifying the need for making recommendations on program procedures and/or policy changes based upon work experiences.
  • Takes responsibility for improving professional skills, participating in planning, and executing specific staff development projects, attending seminars and institutes, and participating in training programs of other disciplines as requested.
  • Provides care coordination (including care management or case management) to Veterans and families, as needed, throughout the continuum of care. This includes communication within and across care lines to facilitate continuity of care for Veterans.
  • Conduct biopsychosocial assessments to assess high risk factors, including suicidal and homicidal ideation, acute needs for VHA or community-based services, and to determine care coordination and treatment needs of Veterans.

Work Schedule:8am-4:30pm
Telework: Not Available
Education Debt Reduction Program (EDRP): Eligible
Virtual: This is not a virtual position.
Functional Statement #: FS# 92176-A /92177-A
Relocation/Recruitment Incentives: Not Authorized
Requirements
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Conditions of employment
  • You must be a U.S. Citizen to apply for this job.
  • Selective Service Registration is required for males born after 12/31/1959.
  • Must be proficient in written and spoken English.
  • Subject to background/security investigation.
  • Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
  • Must pass pre-employment physical examination.
  • Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
  • Complete all application requirements detailed in the "Required Documents" section of this announcement.

As a condition of employment for accepting this position, you will be required to serve a 1 or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:
  • your performance and conduct;
  • the needs and interests of the agency;
  • whether your continued employment would advance organizational goals of the agency or the Government; and
  • whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your trial period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
Qualifications
In order to qualify for this position, you must meet the requirements below within 30 calendar days of the closing date listed on the announcement.
Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.
BASIC REQUIREMENTS. The basic requirements for employment as a VHA social worker are prescribed by statute in 38 U.S.C. § 7402(b)(9), as amended by section 205 of Public Law 106-419, enacted November 1, 2000. To qualify for appointment as a social worker in VHA, all applicants must meet the following:
  • Citizenship. Be a citizen of the United States. (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with chapter 3, section A, paragraph 3g this part).
  • Education. Have a master's degree in social work from a school of social work fully accredited by the Council on Social Work Education (CSWE). Graduates of schools of social work that are in candidacy status do not meet this requirement until the School of Social Work is fully accredited. A doctoral degree in social work may not be substituted for the master's degree in social work. Verification of the degree can be made by going to http://www.cswe.org/Accreditation to verify that the social work degree meets the 3 accreditation standards for a masters of social work.
  • Licensure. Persons hired or reassigned to social worker positions in the GS-0185 series in VHA must be licensed or certified by a state to independently practice social work at the master's degree level. Current state requirements may be found by going to http://vaww.va.gov/OHRM/T38Hybrid/.
  • English Language Proficiency. Candidates must be proficient in spoken and written English to be appointed as authorized by 38 U.S.C. § 7403(f).

Exception. VHA may waive the licensure or certification requirement for persons who are otherwise qualified, pending completion of state prerequisites for licensure/certification examinations. This exception only applies at the GS-9 grade level. For the GS-11 grade level and above, the candidate must be licensed or certified. At the time of appointment, the supervisor, chief social work or social work executive will provide the unlicensed/uncertified social worker with the written requirements for licensure or certification, including the time by which the license or certification must be obtained and the consequences for not becoming licensed or certified by the deadline.Failure to Obtain License or Certification. In all cases, social workers must actively pursue meeting state prerequisites for licensure or certification starting from the date of their appointment. Failure to become licensed or certified within the prescribed amount of time will result in removal from the GS-0185 social worker series and may result in termination of employment.GS-11: Experience and Licensure: Appointment to the GS-11 grade level requires completion of a minimum of one year of post-MSW experience equivalent to the GS-9 grade level in the field of health care or other social work-related settings, (VA or non-VA experience) and licensure or certification in a state at the independent practice level.OREducation: In addition to meeting basic requirements, a doctoral degree in social work from a school of social work may be substituted for the required one year of professional social work experience in a clinical setting. In addition to the experience above, candidates must demonstrate all of the following KSAs:
  1. Knowledge of community resources, how to make appropriate referrals to community and other governmental agencies for services, and ability to coordinate services.
  2. Skill in independently conducting psychosocial assessments and treatment interventions to a wide variety of individuals from various socio-economic, cultural, ethnic, educational and other diversified backgrounds.
  3. Knowledge of medical and mental health diagnoses, disabilities and treatment procedures (i.e. acute, chronic and traumatic illnesses/injuries, common medications and their effects/side effects, and medical terminology) to formulate a treatment plan.
  4. Skill in independently implementing different treatment modalities in working with individuals, families, and groups who are experiencing a variety of psychiatric, medical, and social problems to achieve treatment goals.
  5. Ability to provide consultation services to new social workers, social work graduate students, and other staff about the psychosocial needs of patients and the impact of psychosocial problems on health care and compliance with treatment.

References: VA Handbook 5005/120, Part II, Appendix G39.The full performance level of this vacancy is GS-11.The actual grade at which an applicant may be selected for this vacancy is to GS-11.
Preferred Experience:
1) LISW (Independant SW License) or LSW with relevant experience.
2) Experience in the Substance use Disorders field is preferred.
Physical Requirements: Lifting and carrying light objects under 15 pounds, using two hands, walking for up to two hours. Ability for rapid mental and muscular coordination, correctable vision, hearing with or without aid, depth perception and ability to distinguish basic colors and emotional and mental stability. It requires English language proficiency in accordance with Public Law 102-585, and the ability to effectively communicate in verbal and written formats along with medical clearance by Employee Occupational Health.
Education
Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
Additional information
Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.
During the application process you may have an option to opt-in to make your resume available to hiring managers in the agency who have similar positions. Opting in does not impact your application for this announcement, nor does it guarantee further consideration for additional positions.
This job opportunity announcement may be used to fill additional vacancies.
This position is in the Excepted Service and does not confer competitive status.
VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.
If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.
Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
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Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
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Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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About Veterans Health Administration

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The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving millions of Veterans each year. Located in Phoenix, AZ, and many other parts of the US, the VHA operates under the Department of Veteran Affairs, as suggested by their official website va.gov. The VHA is dedicated to providing the highest level of comprehensive care to its veterans. The organization offers a broad spectrum of medical, surgical, and rehabilitative care, including mental health services, research, and pharmacy benefits.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Phoenix, AZ, US