ZipRecruiter

Log In

1

Utilization Review Np Jobs in Virginia (NOW HIRING)

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job ... review organization, when necessary. • Graduation from an approved/accredited school of nursing ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Education/Requirements: • Graduation from an approved/accredited school of nursing or a Bachelor ...

Akahi Associates, LLC

Nurse Practitioner

Portsmouth, VA · On-site

$145K/yr

... to review and evaluate patient care, identify opportunities for improvement, and recommend ... Promote economic utilization of equipment and supplies, and be cost-conscious when ordering ...

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

next page

Showing results 1-20

All JobsUtilization Review Np JobsUtilization Review Np Jobs in Virginia

Utilization Review Np information

What are some common challenges utilization review nurse practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

What does a utilization review nurse practitioner do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

What are the key skills and qualifications needed to thrive as a utilization review nurse practitioner, and why are they important?

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

What is the difference between Utilization Review Np vs Utilization Review Nurse?

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

What are popular job titles related to Utilization Review Np jobs in Virginia?

For Utilization Review Np jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Review Np jobs in Virginia look for?

The top searched job categories for Utilization Review Np jobs in Virginia are:

What cities in Virginia are hiring for Utilization Review Np jobs?

Cities in Virginia with the most Utilization Review Np job openings:

Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Specialist (Flexi)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Re-posted 8 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Summary
The Utilization Review Specialist supports the organization's utilization management program by conducting routine admission, concurrent, and retrospective reviews utilizing established screening criteria and organizational guidelines. This position collects, reviews, and documents clinical information to support medical necessity determinations and appropriate resource utilization. Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
  • Conduct routine utilization reviews using approved screening criteria, established workflows, and departmental guidelines.
  • Collect and organize clinical documentation necessary to support utilization review activities.
  • Review patient records to identify required information for admission, continued stay, and discharge planning processes.
  • Apply established criteria to routine cases and document findings in designated systems.
  • Monitor assigned cases for required documentation and timely review completion.
  • Communicate with providers, clinical staff, payers, and care team members to obtain necessary information.
  • Identify cases that do not clearly meet established criteria and escalate them to an RN Utilization Review.
  • Present complex, high-acuity, disputed, or clinically ambiguous cases to an RN Utilization Review Specialist for evaluation and determination.
  • Assist with obtaining payer authorizations and tracking authorization status as directed.
  • Maintain accurate utilization management records, reports, and audit documentation.
  • Support denial prevention efforts through timely documentation and communication.
  • Participate in quality improvement initiatives related to utilization management processes.
  • Maintain knowledge of applicable payer requirements, regulatory standards, and organizational policies.
  • Assist with data collection and reporting related to utilization management metrics.
  • Perform other utilization management support duties within the scope of licensure and training.

Supervisory Responsibilities
Reports to: RN Clinical Doc Manager
Supervises: n/a
Responsibilities: n/a
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
Minimum Required Education:
Graduate of an approved healthcare program leading to licensure as a healthcare professional i.e. Licensed Practical Nurse (LPN) or other clinically licensed healthcare professionals as approved by the organization.
Experience:
Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related clinical healthcare functions may be considered.
Certificates, Licenses, Registrations:
Current unrestricted license as a Licensed Practical Nurse required at minimum in the Commonwealth of Virginia or compact state. Candidates possessing a higher level of clinical licensure are also eligible for consideration.
Certification in utilization management or case management preferred.
Physical Demands & Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

What Chesapeake Regional Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply