Utilization Review Technician jobs in Virginia

Utilization Review Technician conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Technician reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

V
Utilization Review Registered Nurse
  • Virginia Commonwealth University Health Systems
  • Richmond, VA FULL_TIME
  • The Utilization Review RN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review.

    This position functions as a part of a multidisciplinary team, including physicians, social workers, discharge planning assistants and payers. The Utilization Review RN performs reviews of current inpatient services, and determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

    The Utilization Review RN conducts prospective, concurrent and retrospective utilization review for inpatient services, observations, as well as specific outpatient service requests.

    Licensure, Certification, or Registration Requirements for Hire: Licensed Registered Nurse in the State of Virginia or eligible Licensure, Certification, or Registration Requirements for continued employment: Current RN licensure in Virginia Complete 15 Continuing Education Units per year Experience REQUIRED: Minimum of three (3) years of nursing experience in an acute care setting Experience PREFERRED One (1) year of Care Coordination experience Clinical experience with specialty patient population Two (2) to Four (4) years of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization (HMO/TPA/IPA/etc.). Proficient in Milliman Care Guidelines (MCG) or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management. Education/training REQUIRED: Bachelors of Science in Nursing from an accredited School of Nursing Education/training PREFERRED: Master's Degree in Nursing or a healthcare related field from an accredited program Case Management Certification Independent action(s) required: Works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization. Works collaboratively with all members of the multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted, and that resources are efficiently and effectively utilized. Utilizes medical necessity criteria as a tool to assess appropriateness of level and setting of care, assists in the denial and appeals process, assesses quality, and identifies and reports potential risk management issues. Responsible for participation in and completion of all patient safety initiatives appropriate to the position. Establishes and maintains a professional rapport with providers, patients/families, and internal customers. Trains and educates new UM staff nurses and new RN Care Coordinators by demonstrating job competency, providing technical instruction and leadership and generally raising the level of performance of others (within and outside of the department) Advocates that the patient is placed in the status and level of care for appropriate remuneration of services rendered. Utilizes clinical application systems with fundamental proficiency in utilization review systems and uses business support applications as needed Supervisory responsibilities (if applicable): N/A Additional position requirements: Ability to flex the schedule as needed to meet the demands of the department Age Specific groups served: All Physical Requirements (includes use of assistance devices as appropriate): Physical Lifting 20-50 lbs. Activities: Prolonged sitting, Repetitive motion Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Able to adapt to frequent change

    Workday Day (United States of America)

    EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.


    VCU Health System Authority (VCU Health) complies with applicable civil rights laws and does not discriminate on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity or expression, age, political affiliation, disabilities, marital status, veteran status, residence, financial status, or any other manner prohibited by law.

     

  • 18 Days Ago

D
Utilization Review Specialist - PRN
  • Dominion Hospital
  • Falls, VA FULL_TIME
  • Introduction Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Utilization Review Specialist - PRN with Dominion Hospital you can be a part ...
  • 1 Month Ago

C
Senior Therapist - Youth Clinical Utilization Review
  • City of Alexandria
  • Alexandria, VA FULL_TIME
  • Senior Therapist – Youth Clinical Utilization ReviewThe City of Alexandria is located in northern Virginia and is bordered by the District of Columbia (Potomac River), Arlington and Fairfax counties. ...
  • 2 Days Ago

T
Pest Control Technician
  • Technician
  • Rocky, VA FULL_TIME
  • Established pest control company seeking to add a technician to our fleet. Need someone dependable that works well as part of a team as well as independently. Detail oriented and good with time manage...
  • 14 Days Ago

H
Plan Review Technician (CD) - Residential
  • Hanover County Government
  • Hanover, VA FULL_TIME
  • Seeking an energetic individual to join our fast-paced, safety oriented team. Interested in learning more about Hanover County's Residential Plan Review process, and the Health, Safety and Welfare of ...
  • 2 Days Ago

N
Low Voltage Cabling Technician
  • Next Level Technician
  • Virginia, VA FULL_TIME
  • Next Level Technician is urgently hiring Low Voltage Cable Technicians for a long-term, career-shaping opportunity in the Virginia Beach VA area! Why work at Next Level Technician? Not only do we offe...
  • 1 Day Ago

F
Tech Expert - Friction Clutch
  • Ford
  • Dearborn, MI
  • Job Description We are the movers of the world and the makers of the future. We get up every day, roll up our sleeves an...
  • 3/27/2024 12:00:00 AM

F
Display Application Technical Expert
  • Ford
  • Dearborn, MI
  • Job Description We are the movers of the world and the makers of the future. We get up every day, roll up our sleeves an...
  • 3/27/2024 12:00:00 AM

F
Switch Team Technical Expert
  • Ford
  • Dearborn, MI
  • Job Description We are the movers of the world and the makers of the future. We get up every day, roll up our sleeves an...
  • 3/27/2024 12:00:00 AM

F
ADAS Hardware Components Technical Expert
  • Ford
  • Dearborn, MI
  • Job Description In this position... We are the movers of the world and the makers of the future. We get up every day, ro...
  • 3/27/2024 12:00:00 AM

K
Technical Expert
  • Kelly Science, Engineering, Technology & Telecom
  • Hauppauge, NY
  • Quality / Reliability Engineer -- Hauppauge, NY - 6 to 12 Month Contract Assignment No C2C or Sponsorship available at t...
  • 3/25/2024 12:00:00 AM

A
Manufacturing Technical Expert (Stamping)
  • American Honda Motor Co Inc
  • Marysville, OH
  • At Honda, The Power of Dreams drives us to create intelligent products that enhance mobility and increase the joy in peo...
  • 3/25/2024 12:00:00 AM

T
System Integration Technical Expert
  • Traxen
  • Plymouth, MI
  • We are a Plymouth, Michigan based startup, developing cutting-edge technologies for Driver Assistance and Automated Driv...
  • 3/25/2024 12:00:00 AM

G
Billing Technical Expert
  • Grow Therapy
  • New York, NY
  • About us: Grow Therapy is on a mission to serve as the trusted partner for therapists growing their practice, and patien...
  • 3/24/2024 12:00:00 AM

Virginia (/vərˈdʒɪniə/ (listen)), officially the Commonwealth of Virginia, is a state in the Southeastern and Mid-Atlantic regions of the United States located between the Atlantic Coast and the Appalachian Mountains. Virginia is nicknamed the "Old Dominion" due to its status as the first English colonial possession established in mainland North America and "Mother of Presidents" because eight U.S. presidents were born there, more than any other state. The geography and climate of the Commonwealth are shaped by the Blue Ridge Mountains and the Chesapeake Bay, which provide habitat for much of ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Technician jobs
$62,389 to $87,055

Utilization Review Technician in Little Rock, AR
Based on our compensation data, the estimated salary potential for Utilization Review Technician will increase 16 % over 5 years.
February 07, 2020
Utilization Review Technician in Fairbanks, AK
Current National Pharmacy Technician Certification (PTCB, ExCPT or NCCT) required.
February 03, 2020
Utilization Review Technician in Winston Salem, NC
When considering cost of living, this places Durham, NC as 3rd out of the 4 largest nearby metros in terms of quality of life for Utilization Review Technicians**.
January 02, 2020