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Utilization Management Auditor Jobs in Virginia (NOW HIRING)

Senior Accountant

Petersburg, VA

$72K - $91K/yr

Senior Accountant This position is responsible for managing the full cycle of accounting, ensuring ... Prepare audit schedules and provide documentation for internal and external auditors * Monitor and ...

... benefit and utilization review policies and criteria for emerging treatments, technology ... Auditing, ICD-10 CM, CPT, HCPCS, QNXT and Revenue coding in a managed care setting Benefits: Caring ...

Technical Architect

Haymarket, VA · On-site

$175K - $210K/yr

Prioritize, manage, and deliver data projects through effective resource and risk management ... Establish continuous auditing/monitoring for data usage, access violations, and compliance ...

Bachelor's degree in Engineering, Risk Management & Insurance, Health and Safety, or similar ... Experience with compliance, auditing, governance, and reporting processes * Experience managing ...

... auditing, and reporting requirements * Financial and Resource Management * Supporting the program ... Tracking labor costs, productivity, and resource utilization to achieve desired outcomes, and ...

Showing results 21-40

Utilization Management Auditor information

What is the difference between Utilization Management Auditor vs Utilization Review Nurse?

AspectUtilization Management AuditorUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or CUCLicensed Registered Nurse (RN), often with additional certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinics, insurance companies, often in clinical settings
Primary FocusAuditing and reviewing utilization data for compliance and cost managementAssessing patient care needs and determining appropriate services

While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.

What are some common challenges faced by utilization management auditors and how can they be addressed?

Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.

What is a utilization management auditor?

A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.

What are the key skills and qualifications needed to thrive as a utilization management auditor?

To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
What are popular job titles related to Utilization Management Auditor jobs in Virginia? For Utilization Management Auditor jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Management Auditor jobs in Virginia look for? The top searched job categories for Utilization Management Auditor jobs in Virginia are:
What cities in Virginia are hiring for Utilization Management Auditor jobs? Cities in Virginia with the most Utilization Management Auditor job openings:
Infographic showing various Utilization Management Auditor job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Internal Revenue Agent (Excise Tax Specialist)

Criminal Investigation & Law Enforcement | IRS Careers

Richmond, VA • On-site

$74K/yr

Other

Posted 18 days ago


Job description

WHAT IS SMALL BUSINESS / SELF-EMPLOYED (SB/SE) DIVISION?
A description of the business units can be found at: https://www.jobs.irs.gov/about/who/business-divisions

  • Position(s) are to be filled in the following area(s):
    • SBSE EXAM - Examination Deputy Operations - Specialty Examination, Estate & Gift /Excise Tax Exam

REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS

Qualifications:

Federal experience is not required. Experience may have been gained in the public sector, private sector or through Volunteer Service. One year of experience refers to full-time work; part-timework is considered on a prorated basis. To ensure full credit for your work experience, please indicate dates of employment by month/day/year, and indicate number of hours worked per week, on your resume.
You must meet the following requirements by the closing date of this announcement.

QUALIFICATION REQUIREMENTS: To qualify for this position, you must meet the qualification requirements outlined below:
BASIC REQUIREMENTS All GRADES: A Certificate as a Certified Public Accountant (CPA) or a bachelor's or higher degree in accounting that included at least 30 semester hours in accounting or 24 semester hours in accounting and an additional 6 semester hours in related subjects such as business law, economics, statistical/quantitative methods, computerized accounting or financial systems, financial management, or finance.
OR
a combination of education and experience equivalent to 4 years that that included courses equivalent to a major in accounting, i.e., at least 30 semester hours in accounting or 24 semester hours in accounting and 6 semester hours in related subjects as described above, in combination with appropriate experience or additional education.
AND
Specialized Experience GS-11:
In addition to the basic requirements, you must have 1 year of specialized experience at a level of difficulty and responsibility equivalent to the GS-09 grade level in the Federal service. Specialized experience for this position includes:

  • Experience in or related to accounting or auditing that provided the specific knowledge, skills and abilities needed to successfully perform the duties of the position. Qualifying experience may have been in accounting, auditing, tax, financial, legal, or other work that required the knowledge and skill described above to sufficiently demonstrate: 1) Knowledge of and skill in applying professional accounting principles, concepts, and methodology to the examination of accounting books, records, and systems; 2) skill in interpreting and applying tax law for individuals and business and/or exempt organizations; 3) knowledge of business and trade practices to analyze business operations and financial conditions; and 4) skill in interacting effectively in a wide range of situations with a broad range of individuals.
Examples of qualifying experience may include: (This list is not all inclusive)
  • Experience in interpreting and applying professional accounting and auditing techniques, and practices to examine various tax returns of individuals and/or business organizations.
  • Experience examining accounting systems and records including computerized accounting and financial information systems which reflect a variety of complex financial operations (e.g., budgeting and planning, cash flow monitoring and forecasting, financial reporting, cost tracking, asset valuation and utilization).
  • Experience with the interpretation and application of Federal tax law in the examination of tax returns for individuals, business and/or exempt organizations, partnerships, and corporations.
  • Experience assisting with the recommendation and implementation of Federal tax strategies (i.e., excise tax, income tax, etc.). Drafting, consolidating, and reviewing financial statements.
  • Knowledge of federal tax and auditing guidelines related to common deductions, asset/liability reporting.
  • Knowledge of internal controls and conducting audits as part of a team.
OR
EDUCATION: A course of study that includes three (3) years of progressively higher-level graduate education leading to a Ph.D. degree or Ph.D. or equivalent doctoral degree in accounting or related field of business law, economics, statistical/quantitative methods, computerized accounting or financial systems, financial management, or finance.
OR
an equivalent amount of combined education and experience as described in paragraphs above
Specialized Experience GS-12: In addition to the basic requirements, you must have 1 year of specialized experience at a level of difficulty and responsibility equivalent to the GS-11 grade level in the Federal service. Specialized experience for this position includes:
  • Qualifying experience in progressively responsible and diversified professional accounting or auditing work that required 1) knowledge of and skill in applying professional accounting principles, theory, and practices to analyze and interpret accounting books, records, or systems specifically to determine their effect on Federal tax liabilities and their adequacy for recording transactions affecting tax liabilities; 2) skill in interpreting and applying Federal tax law for individuals, business, and/or exempt organizations, partnerships, and corporations; 3) knowledge of business and trade practices to develop tax issues based on analysis and evaluation of overall business operations and financial condition; 4) knowledge of corporate financial transactions and financial management principles and practices; and 5) skill in interacting effectively with a broad range of individuals and in negotiating with specialists in accounting, legal, tax, and other similar business-related professions.
Examples of qualifying experience may include (this list is not all inclusive):
  • Experience preparing written reports and analyses and articulating and communicating results orally and in writing.
  • Experience leading risk assessments, evaluations, and reviews to strengthen accounting controls; lead and conduct internal/external audits; overseeing tax management;
  • Experience with the interpretation and application of more complex Federal tax law (e.g., conservation easement, Micro-captive insurance, Employee retention credit, Research and Development credits, Taxation of cryptocurrency and other digital assets, Pass-through entities (BBA), Transfer pricing operations) in the examination of tax returns for individuals, business and/or exempt organizations, partnerships, and corporations. Leading the implementation and oversight of company tax return, revenue, and expense reporting.
  • Experience conducting examinations of special audit features complex individual and business taxpayers involved in or activities or transactions designated or structured to hide or conceal income such as offshore activities, multiple related entities and other means using a wide range of financial and other investigative skills.
  • Knowledge of internal controls and leading team audits.
  • Leads the implementation and oversight of company tax return, revenue, and expense reporting.


AND
You must also meet the following requirements:

  • MINIMUM AGE REQUIREMENT: Minimum age for federal employment is 18 years old, or at least 16 years old and have:
    • Graduated from high school or been awarded a certificate equivalent to graduating from high school; or
    • Completed a formal vocational training program; or
    • Received a statement from school authorities agreeing with your preference for employment rather than continuing your education.

For more information on qualifications please refer to OPM's Qualifications Standards.

Education:A college or university degree generally must be from an accredited (or pre-accredited) college or university recognized by the U.S. Department of Education. For a list of schools which meet these criteria, please refer to Department of Education Accreditation page.
FOREIGN EDUCATION: Education completed in foreign colleges or universities may be used to meet the requirements. You must show proof the education credentials have been deemed to be at least equivalent to that gained in conventional U.S. education program. It is your responsibility to provide such evidence when applying. Click here (Section 3, Explanation of Terms) or here for Foreign Education Credentialing instructions.
We recommend choosing an evaluator from a member organization of one of the following national associations of credential evaluation services: National Association of Credential Evaluation Services (NACES) or Association of International Credentials Evaluators (AICE).Employment Type: OTHER