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Utilization Management Clinical Analyst Jobs in Virginia

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

Epic Clinical Analyst II, Ambulatory

Alexandria, VA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

Epic Clinical Analyst III

Alexandria, VA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

Experience: • Seven years of experience in systems deployment as a clinical analyst, business ... Must possess strong communication and organization skills. • Proven project management experience ...

Epic Clinical Analyst II, Ambulatory

Alexandria, VA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

Epic Clinical Analyst II, ClinDoc

Alexandria, VA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

... clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management ...

Epic Clinical Analyst II, Optime

Alexandria, VA

$87K - $161K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

Epic Clinical Analyst II, Ambulatory

Alexandria, VA · On-site

$87K - $161K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

Epic Clinical Analyst II, ClinDoc

Alexandria, VA · On-site

$78K - $143K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

Epic Clinical Analyst II, Ambulatory

Alexandria, VA · On-site

$87K - $161K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic ...

User management in Sunquest. Configuration / Troubleshooting of Printers and send out tests. Knowledge on different types of interfaces, background running applications and functionality ...

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

  • Medical

  • Dental

  • Vision

  • PTO

... clinically valid criteria which meets the daily deadlines to obtain authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management ...

Showing results 21-40

Utilization Management Clinical Analyst information

How does a utilization management clinical analyst typically collaborate with clinical and administrative teams to ensure optimal patient care?

A Utilization Management Clinical Analyst works closely with both clinical staff, such as nurses and physicians, and administrative teams to review patient cases and ensure that treatments and services are medically necessary and align with payer guidelines. This role often involves participating in interdisciplinary meetings, communicating findings and recommendations, and helping to develop or refine care protocols. Effective collaboration is essential to balance quality patient care with cost efficiency, and analysts regularly provide feedback and support to improve clinical workflows and documentation.

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

To thrive as a Utilization Management Clinical Analyst, you need a solid background in healthcare, strong analytical abilities, and credentials such as RN or LPN licensure or relevant clinical certifications. Familiarity with utilization management software, electronic health records (EHRs), and claims processing systems is typically required. Excellent communication, critical thinking, and attention to detail are soft skills that help you collaborate effectively and make sound clinical determinations. These competencies are crucial for ensuring the appropriate use of medical resources, maximizing patient outcomes, and maintaining regulatory compliance.

What does a utilization management clinical analyst do?

A Utilization Management Clinical Analyst reviews and analyzes medical records, claims, and treatment plans to ensure that healthcare services provided to patients are medically necessary and cost-effective. They work with healthcare providers, insurance companies, and patients to evaluate the appropriateness of medical care based on established guidelines and policies. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulatory standards.

What is the difference between Utilization Management Clinical Analyst vs Utilization Review Nurse?

AspectUtilization Management Clinical AnalystUtilization Review Nurse
CredentialsHealthcare degree, certifications like CCM or CUCRegistered Nurse (RN), state licensure, certifications like CCM
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, insurance companies, outpatient facilities
Employer & IndustryHealth insurance providers, managed care organizationsHospitals, insurance companies, healthcare facilities
Common Search & ComparisonUtilization Management Clinical Analyst vs Utilization Review Nurse

The main difference between a Utilization Management Clinical Analyst and a Utilization Review Nurse lies in their focus and credentials. Clinical Analysts often have healthcare degrees and certifications like CCM, working primarily in insurance or managed care settings. Utilization Review Nurses are registered nurses with licensure, working in hospitals or outpatient facilities. Both roles involve reviewing medical necessity, but their work environments and professional backgrounds differ.

What are popular job titles related to Utilization Management Clinical Analyst jobs in Virginia?

For Utilization Management Clinical Analyst jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Management Clinical Analyst jobs in Virginia look for?

The top searched job categories for Utilization Management Clinical Analyst jobs in Virginia are:

What cities in Virginia are hiring for Utilization Management Clinical Analyst jobs?

Cities in Virginia with the most Utilization Management Clinical Analyst job openings:

Infographic showing various Utilization Management Clinical Analyst 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.

Epic Clinical Analyst II, Ambulatory

VHC Health

Alexandria, VA

Full-time

Medical, Dental, Vision, Retirement

Posted 18 days ago


VHC Health rating

8.0

Company rating: 8.0 out of 10

Based on 34 frontline employees who took The Breakroom Quiz

87th of 887 rated healthcare providers


Job description

Position TitleEpic Clinical Analyst II, AmbulatoryJob Description

Purpose & Scope:

This position is an intermediate level analyst position that develops Epic application solutions as well as other 3rd party clinical systems by investigating processes to understand data and communications flow with individual tasks and transactions. The analyst typically fulfills multiple roles throughout the development, implementation, management, and on-going support of comprehensive clinical information systems. Gains knowledge of the Epic EMR software, as well as medical center operations and workflow, and works closely with the Epic project team's application analysts and clinical leaders to translate business needs into EMR functionality.This individual participates in the development of workflows, system configuration, change documentation, and training staff on EPIC clinical application functionality. Analyzes procedures and problems within manual/automated health care systems; reports findings and when applicable recommends options for resolutions. Formulates system scope and objectives. Confers with professional staff to ascertain specific requirements and assists in the completion of programming specifications. This requires the individual to stay current with the system and/or application as well as interfacing with appropriate departmental and external analysts. Must employ excellent communication skills in sharing information with users within department.Works independently in completing project tasks and executing the following tasks as part of a clinical systems implementation: building system components; testing, documentation of workflows and other project information; implementation support and maintenance of Epic clinical system software; builds data sets, master files and reports; performs quality assurance and integrated testing and releases new functionality to end-users; reviews vendor software releases and updates; provides 24/7 problem management support (On-Call) and resolution for clinical systems. In addition this position requires the ability to independently interact with clients and demonstrate critical thinking and follow through when developing solutions to identified issuesKey attention to the build and workflow requirements needed to achieve and maintain federal incentive programs, for example, Meaningful Use. Dedicated attention and resources to make rapid adjustments to improve compliance to federal initiative, reporting of outcomes related to patient safety and quality.The Clinical Systems Applications Analyst II is responsible for establishing credibility at all levels including clinical providers and builds problem-solving partnerships with customers and colleagues.

Education:

Bachelor's degree is required (or four years of equivalent experience). Preferred degree in: Health Care Administration, Clinical Information Systems, Informatics, Information Technology, or Sciences. RN, RRT, RPH, ARNP, PA degrees may also be acceptable.

Experience:

Five years of progressive healthcare industry experience preferably in a hospital or major medical center clinical setting required. Three years of experience in systems deployment as a clinical analyst, business analyst, or systems analyst required. This includes designing, configuring, training, implementing, and supporting clinical systems applications. Healthcare operations background is desirable. Knowledge of operational healthcare hospital workflows including clinical and business workflow analysis for development of electronic solutions within assigned applications is preferred. Hands-on Epic clinical systems experience with appropriate Epic training in at least one area is preferred. Demonstrated technical administrative experience with Epic clinical applications, including but not limited to master file maintenance and clinical build (i.e. smart sets, order sets, documentation flowsheets). Experience supporting Epic clinical systems, with design, build and validate experience preferred. Proficient knowledge of and ability to employ systems analysis concepts, techniques, industry best practices, tools and standards. Proficient knowledge of and ability to employ software quality assurance and testing concepts, techniques, industry best practices, tools and standards. Experience in project planning and procedural analysis preferred. Proficient knowledge of and ability to work with SDLC concepts. Excellent written and oral communications skills, especially active listening and writing

Certification/Licensure:

Epic Certification: application specific to be obtained within six months.

Additional Job Description

At VHC Health, every role contributes to exceptional care, better outcomes, and stronger communities.  In addition to your base compensation, VHC Health offers a comprehensive benefits package, including medical, dental, and vision coverage (subject to eligibility requirements), as well as additional wellness and retirement benefits designed to support our employees and their families.  VHC Health is committed to wage transparency and equitable pay practices. The compensation offered for this position-whether expressed as an annual salary or hourly rate-is determined based on a variety of legitimate, non-discriminatory factors. These factors include, but are not limited to, a candidate's qualifications, relevant training and experience, skill level, shift differentials (where applicable), internal equity, and current market conditions.  The posted hiring range reflects the range VHC Health, in good faith, believes is appropriate for this role at the time of posting. This range may be adjusted in the future based on business needs or market changes. No portion of compensation is considered earned until it is vested and determined in accordance with the terms of applicable policies and benefit plans. The availability and amount of any bonuses, incentives, or other benefits are subject to the terms of those plans and may be modified at the sole discretion of VHC Health, in accordance with applicable law.  VHC Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.  VHC Health maintains a drug-free workplace. The unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited at all VHC Health locations. 

Employment Type: FULL_TIME

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