Fishersville, VA · On-site
$35.43 - $54.21/hr
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on ...
Fishersville, VA · On-site
$35.43 - $54.21/hr
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on ...
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on ...
New
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on ...
New
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on ...
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on ...
Richmond, VA · On-site
The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... as well as weekend coverage (i.e. Wed-Sun, Thu-Mon or Fri-Tue type schedule). This will be ...
Richmond, VA · On-site
The RN Review Nurse works closely with healthcare providers, interdisciplinary teams, and non ... as well as weekend coverage (i.e. Wed-Sun, Thu-Mon or Fri-Tue type schedule). This will be ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Danville, VA · On-site
... review and respond to concerns expressed by customers. Together with the appropriate Department ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...
Danville, VA · On-site
... review and respond to concerns expressed by customers. Together with the appropriate Department ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...
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 ...
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 ...
Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...
Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...
Danville, VA · On-site
$26 - $35/hr
... Utilization Review Reports as necessary. • Coordinates and makes Retrospective Appeals to third party payers. • Meets weekly with Administrator on appropriate issues. • Other duties as assigned ...
Danville, VA · On-site
$26 - $35/hr
... Utilization Review Reports as necessary. • Coordinates and makes Retrospective Appeals to third party payers. • Meets weekly with Administrator on appropriate issues. • Other duties as assigned ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
Roanoke, VA · On-site
Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Provide hand-off communication of unit needs to peers during weekday/weekend transitions What We ...
$21.21 - $25.50
2% of jobs
$25.50 - $29.79
9% of jobs
$32.73 is the 25th percentile. Wages below this are outliers.
$29.79 - $34.08
21% of jobs
The median wage is $37.55 / hr.
$34.08 - $38.37
23% of jobs
$38.37 - $42.66
13% of jobs
$46 is the 75th percentile. Wages above this are outliers.
$42.66 - $46.95
10% of jobs
$46.95 - $51.24
8% of jobs
$51.24 - $55.53
5% of jobs
$55.53 - $59.82
5% of jobs
$59.82 - $64.11
2% of jobs
$64.11 - $68.40
2% of jobs
$21
$41
$68
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.
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.
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.
Fishersville, VA • On-site
$35.43 - $54.21/hr
Part-time
Medical, Retirement, PTO
Posted 4 days ago
The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on the patient care units. This position works closely with admitting and attending providers as well as the Utilization Management Physician Advisor to ensure patient status is accurate and compliant with regulatory standards. The Utilization Review RN Case Manager is viewed by clinical teams as an expert in the building when it comes to selecting the appropriate level of service for patients. They participate in multidisciplinary discharge rounds on the hospital units to understand clinical course, discharge plans and possible changes in medical necessity, all toward selecting the levels of care that match clinical necessity. This position plays an essential role in securing reimbursement to the hospital for services provided by commercial, Medicaid and Medicare payers through timely communication and submission of relevant clinical information to the payer when required. The effective tending of utilization review lowers the frequency of avoidable denials by payers for services provided. This role ensures adherence to the policies and guidelines of all payer review organizations to secure appropriate reimbursement for patient hospitalizations. During normal business hours this position may screen patients to determine if case management follow-up is required.
Minimum Qualifications
Preferred Qualifications
Skills
Some benefits of working at Augusta Health include
Company Information
Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.
Equal Opportunity
Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.
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