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Weekend Utilization Review 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 ...

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

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 ...

State of Virginia

RNCA

Petersburg, VA · On-site

$84K - $116K/yr

Applications/resumes will begin to be reviewed within five (5) days of the posting date. Background Investigation: All applicants are subject to an extensive background investigation and a pre ...

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Weekend Utilization Review information

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How much do weekend utilization review jobs pay per hour?

As of Jun 13, 2026, the average hourly pay for weekend utilization review in Virginia is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

What does a typical weekend shift look like for a Utilization Review professional?

Weekend Utilization Review professionals typically work independently, reviewing patient cases for medical necessity, appropriateness of care, and compliance with payer guidelines during non-standard business hours. You will analyze patient charts, interact with clinical staff, and document findings, often collaborating remotely with other care coordinators or medical teams. While much of the role is desk-based, quick decision-making and effective communication are essential due to faster-paced weekend workflows. This schedule can offer greater autonomy and flexibility, but may also require prioritizing tasks and managing multiple cases efficiently to ensure continuous patient care.

What is a Weekend Utilization Review job?

A Weekend Utilization Review job involves assessing patient care and medical services during weekends to ensure they meet medical necessity and insurance guidelines. Professionals in this role review clinical documentation, coordinate with healthcare providers, and determine appropriate levels of care for patients. They typically work for hospitals, insurance companies, or other healthcare organizations. Strong analytical skills, medical knowledge, and familiarity with regulatory requirements are essential for success in this role.

What are the key skills and qualifications needed to thrive in the Weekend Utilization Review position, and why are they important?

Success as a Weekend Utilization Review professional requires a strong background in nursing or healthcare, critical thinking skills, and a thorough understanding of medical necessity criteria, such as InterQual or Milliman guidelines. Familiarity with electronic medical records (EMR) systems and utilization management software is highly beneficial, and RN or healthcare-related licensure is often required. Exceptional communication, attention to detail, and the ability to work independently on weekends are crucial soft skills. Mastering these areas allows efficient and accurate reviews of patient care, supporting optimal healthcare resource allocation outside of standard work hours.

What are the most commonly searched types of Utilization Review jobs in Virginia? The most popular types of Utilization Review jobs in Virginia are:
What are popular job titles related to Weekend Utilization Review jobs in Virginia? For Weekend Utilization Review jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Weekend Utilization Review jobs in Virginia look for? The top searched job categories for Weekend Utilization Review jobs in Virginia are:
What cities in Virginia are hiring for Weekend Utilization Review jobs? Cities in Virginia with the most Weekend Utilization Review job openings:
Weekend Utilization Review jobs near you

Utilization Review/Continuous Quality Improvement Specialist

Frederick County, VA

Winchester, VA • On-site

$65K - $75K/yr

Full-time

Medical, Dental, Vision, Life

Posted 18 days ago

Job description

Salary: $65,280.00 - $75,000.00 Annually
Location : 107 N Kent. St., Winchester, VA
Job Type: Full-Time
Job Number: 00710
Department: CHILDREN'S SERVICES ACT
Opening Date: 05/26/2026
Description
We are seeking a detail-oriented and clinically driven UR/CQI Specialist to support quality assurance and continuous improvement efforts for Children's Services Act (CSA) programs. This role is responsible for reviewing high-risk and complex cases and ensuring that services are effective, family-centered, and compliant with CSA requirements and local policies. The ideal candidate will bring strong analytical skills, clinical expertise, and a commitment to improving outcomes for youth and families through collaboration, provider oversight, and data-informed recommendations.
What You'll Do:
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Conduct utilization reviews for CSA-funded youth and family cases, including congregate care placements, high-utilization services, and other high-risk or clinically complex cases.
  • Review assessments, CANS, IFSPs, treatment plans, progress reports, and related documentation to ensure services are clinically appropriate, effective, and least restrictive and aligned with identified needs and CSA expectations.
  • Assess whether services are clinically appropriate, least restrictive, fiscally responsible, and responsive to the youth and family's documented needs, strengths, functioning, and treatment goals.
  • Conduct interviews and gather information from youth, families, caregivers, case managers, service providers, and partner agencies to support utilization review and continuous quality improvement efforts.
  • Prepare written UR/CQI findings, summaries, and recommendations, and provide professional guidance to FAPT, IFT, and other multidisciplinary teams regarding level of care, treatment progress, discharge planning, service alternatives, and service gaps.
  • Monitor provider compliance with contractual expectations, treatment planning requirements, monthly reporting standards, incident reporting, licensing concerns, and overall quality-of-care expectations through chart reviews, provider meetings, and site visits.
  • Track service utilization patterns, treatment outcomes, provider performance concerns, and systemic barriers to support continuous quality improvement initiatives, outcome monitoring, and programmatic enhancements.
  • Provide consultation and technical assistance related to CANS-informed service planning, evidence-based interventions, progress monitoring, discharge planning, audits, policy implementation, training activities, and confidentiality compliance.
  • Maintains confidential records and communications in accordance with CSA requirements, local policies, HIPAA/FERPA, where applicable, and other confidentiality requirements.
  • Performs other duties as assigned.

What We're Looking For:
EDUCATION: Master's Degree in Social Work, Counseling, Psychology, Marriage and Family Therapy, Human Services, or a closely related field required.
EXPERIENCE: Minimum one year of experience in behavioral health, child welfare, juvenile justice, special education, or children's services required. Experience with utilization review, treatment planning, residential care, Medicaid behavioral health services, CSA, CANS, or provider quality assurance preferred. Related internship experience may be considered.
CERTIFICATES, LICENSES AND/OR REGISTRATIONS: Clinical license or license-eligible status in Virginia preferred. Must be proficient in the CANS and become certified as a CANS SuperUser within 30 days of employment or within the timeframe approved by the CSA Coordinator. Must possess a valid driver's license.
OTHER KNOWLEDGE, SKILLS AND ABILITIES: Requires strong clinical assessment, documentation review, analytical, written, and verbal communication skills. Ability to interpret and apply complex policies, contracts, and treatment documentation while exercising sound clinical judgment in time-sensitive situations. Must collaborate effectively with families, providers, and partner agencies, manage conflict professionally, and work independently under strict deadlines. Proficiency with Microsoft 365 and standard office technology required. Knowledge of CSA, CANS, Medicaid behavioral health services, evidence-based practices, and licensing standards preferred.
Supplemental Information
PHYSICAL DEMANDS: Requires regular physical activity, including walking, standing, sitting, writing, typing, bending, and operating office equipment. Work involves preparing and analyzing data and observing community and service settings. Must be able to travel independently to provider sites, schools, courts, homes, and other community locations approximately 25-50% of the time.
ENVIRONMENTAL CONDITIONS: Primary workspace is a heated and air-conditioned office. Duties require travel to provider locations, schools, homes, meetings, and other community settings as assigned. In-person attendance at FAPT, provider meetings, site visits, and other meetings may be required based on operational needs.
To learn more about Frederick County, Virginia employee benefits, please visit the following webpage:
All positions are subject to a criminal background check for any convictions that relate to the job duties and responsibilities. Frederick County Virginia Government is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
The County's EEO Utilization Report is available at www.fcva.us/jobs
There are a wide variety of benefits available to Frederick County employees. These benefits include: health, dental, vision, life insurance, optional life and disability plans, flexible spending account for health care, dependent care assistance program, an employee assistance program and a deferred compensation program.
Please click to view our Frederick County Employee Benefits information page with full details on all insurance plans offered.

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