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Weekend Utilization Review Jobs in West Virginia

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

WVU Medicine

RN-ACT

Morgantown, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

WVU Medicine

RN-ACT

Clarksburg, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

WVU Medicine

RN-ACT

Morgantown, WV · On-site

Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care. Work is performed in accordance with ...

Interim HealthCare

RN Case Manager (Visits)

Morgantown, WV · On-site

$70K - $80K/yr

... Weekends * Daily Pay option available * No Overtime Required * 1:1 patient care Excited to hear ... utilization review experience preferred. OASIS experience preferred. Practical trach and/or ...

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Weekend Utilization Review information

What does a weekend utilization review professional do?

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?

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?

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 West Virginia? The most popular types of Utilization Review jobs in West Virginia are:
What are popular job titles related to Weekend Utilization Review jobs in West Virginia? For Weekend Utilization Review jobs in West Virginia, the most frequently searched job titles are:
What job categories do people searching Weekend Utilization Review jobs in West Virginia look for? The top searched job categories for Weekend Utilization Review jobs in West Virginia are:
Weekend Utilization Review jobs near you
Infographic showing various Weekend Utilization Review job openings in West Virginia as of August 2026, with employment types broken down into 3% As Needed, 75% Full Time, 19% Part Time, and 3% Contract. Highlights an 94% In-person, and 6% Remote job distribution.

Regional RAI Specialist RN

Majestic Care

Nutter Fort, WV

Full-time

Posted 16 days ago

Majestic Care rating

5.3

Company rating: 5.3 out of 10

Based on 42 frontline employees who took The Breakroom Quiz

190th of 239 rated social care providers

Job description

Majestic Care is looking for a Regional RAI Specialist in West Virginia to join our teams’ mission and believe in our core values!

Our mission: Through the hearts of our Care Team Members, we provide excellent healthcare to those we serve.

Our Core Values... 

L - Listening

E - Empathy

A - Accountability

D - Decisiveness 

This is how we create a culture to LEAD with Love. 


Position Overview:

Provides education and training to communities on the resident assessment instrument (RAI) process in accordance with all laws, regulations, and standards. Reviews and coordinates PPS and case mix data for the entire company to ensure appropriate utilization of available resources.

Key Responsibilities:

  • Review and coordinate PPS and case mix data for entire company to ensure appropriate utilization of available resources.

  • Review MDS Detail and RUGS monthly or more frequently as needed for each community.

  • Be involved in recruitment, selection, and training of MDS team members.

  • Establish and evaluate MDS system for accuracy and timeliness.

  • Prepare clinical team on MDS process.

  • Prepare community for MDS issues and concerns during survey process.

  • Performs other tasks as assigned and within scope of practice.

    Qualifications:

  • Excellent verbal and written communication skills.

  • Proficient in Word, Excel, email.

  • Must be willing to travel as needed.

  • Ability to provide training to professional and entry level team members.

  • Knowledge of nursing practices and procedures as well as laws, regulations, and guidelines governing nursing functions in long-term care.

  • Ability to plan, organize, develop, implement, and interpret programs, goals, objectives, policies, and procedures of clinical services.

  • Ability to maintain confidentiality of sensitive information.

  • Must have nursing degree from an accredited college – RN necessary.

  • Must have 1 year of working with RAI process and PPS.

Other Special Requirements:

  • Manual dexterity required to operate modern office equipment.

  • Valid driver’s license for travel as needed.

 #HiMed

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