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Utilization Review Job Jobs in Virginia (NOW HIRING)

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which ...

Summit BHC

Utilization Assistant- Acute

Williamsburg, VA · On-site

$20 - $24/hr

Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources. Roles and Responsibilities: • Assists the admissions ...

UHS

UTILIZATION COORDINATOR

Danville, VA

... review and respond to concerns expressed by customers. Together with the appropriate Department ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ... or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...

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Utilization Review Job information

What is the difference between Utilization Review Job vs Case Manager?

AspectUtilization Review JobCase Manager
CredentialsOften requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalTypically requires social work, nursing, or healthcare-related certifications, such as LCSW or RN
Work EnvironmentHospitals, insurance companies, healthcare facilities, or managed care organizationsHospitals, community health agencies, insurance companies, or social service organizations
Employer & Industry UsageUsed in insurance, healthcare, and managed care to evaluate medical necessityUsed in healthcare, social services, and insurance to coordinate patient care and support services

While both roles involve healthcare assessment, Utilization Review Jobs focus on evaluating the necessity of medical services, often within insurance or managed care settings. Case Managers, on the other hand, coordinate patient care and support services, addressing broader patient needs. Both roles require healthcare credentials and work in similar environments, but their primary functions differ in scope and responsibilities.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on individual workload, work environment, and experience. Strong organizational skills and knowledge of healthcare policies can help manage job-related stress.

What jobs pay 4000 a week without a degree?

In utilization review roles, such as senior or experienced reviewers, it is possible to earn around $4,000 weekly, especially with extensive experience, certifications, or working in high-demand healthcare settings. These positions often require strong analytical skills, knowledge of medical terminology, and familiarity with healthcare policies, but they typically do not require a college degree.

What does a utilization reviewer do?

A utilization reviewer's role involves evaluating medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure that care complies with insurance policies and industry standards, often using healthcare management software and requiring knowledge of medical guidelines. This process helps control costs and supports quality patient care.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in clinical settings or insurance is often required, along with knowledge of medical coding and utilization review processes; some employers may also require certification such as the Certified Professional in Healthcare Quality (CPHQ).
What cities in Virginia are hiring for Utilization Review Job jobs? Cities in Virginia with the most Utilization Review Job job openings:
Utilization Review Job jobs near you
Clinical Coordinator - Utilization Review

Clinical Coordinator - Utilization Review

Hampton-Newport News Community Services Board

Hampton, VA

$62K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 24 days ago

Job description

Clinical Coordinator - Utilization Review

Annual Salary: $62,406

Work Schedule: Monday - Friday 8:30 am - 5:00 pm

The Hampton - Newport News Community Services Board (CSB) is hiring a Clinical Coordinator - Utilization Review for the Region 5 Reinvestment Initiative. This full-time Clinical Coordinator - Utilization Review is responsible for conducting clinical reviews of acute and intermediate care for clinical necessity and appropriateness of care and for managing utilization of beds on a daily basis to ensure movement in a clinically appropriate and expeditious manner. Major duties will include conducting clinical reviews, acute care bed management, and communication of findings and recommendations between hospitals, facilities, and CSB staff. This position will report to the Project Director of the Region 5 Reinvestment Initiative.

ROLE SUMMARY

The Clinical Coordinator (Utilization Review) ensures individuals receive the most appropriate and effective behavioral health services by conducting clinical reviews of acute care and crisis stabilization admissions. Evaluates medical necessity, monitors continued stay criteria, and makes recommendations regarding the most appropriate level of care. Working closely with hospitals, Community Services Board (CSB) staff, and regional partners, coordinates communication, tracks consumer placements, and provides clinical guidance to support informed treatment and placement decisions. Responsibilities include conducting face-to-face assessments, monitoring treatment progress and outcomes, promoting quality and cost-effective care, and preparing regular utilization reports with recommendations for acute, sub-acute, or community-based services. This position plays a critical role in ensuring consumers receive timely, clinically appropriate, and least restrictive treatment options while supporting regional behavioral health initiatives.

To qualify for this position, candidates must have:

  • Master's degree in Human Services.
  • Three (3) years of experience in behavioral health, including utilization management.

BENEFITS

  • Health, Vision, and Dental Insurance
  • Virginia Retirement System
  • Flexible Spending Account (FSA)
  • Life Insurance
  • 11 Paid Holidays

The selected candidate must successfully pass a criminal history fingerprint background investigation, DMV record check, Child Registry search, drug screening test and employment reference checks.

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