Healthcare Utilization Specialist

6 days ago


Charlottesville, Virginia, United States State of Virginia Full time
Job Summary

We are seeking a skilled Healthcare Utilization Specialist to join our team at the State of Virginia. In this role, you will play a critical part in promoting regulatory compliance and ensuring the highest quality care for patients.

About the Role

The ideal candidate will have a strong background in nursing and experience working in acute care settings. You will be responsible for conducting medical necessity reviews, collaborating with healthcare teams, and utilizing your clinical expertise to make informed decisions.

Key Responsibilities
  • Conduct initial concurrent and retrospective medical necessity reviews
  • Collaborate with physicians and other healthcare professionals to promote regulatory compliance
  • Analyze and evaluate complex medical documentation
  • Utilize judgment and critical thinking to determine case referrals and appeals
Requirements

To be successful in this role, you will need:

  • A Bachelor of Science in Nursing from an accredited program
  • At least 2 years of acute care hospital experience
  • Licensure to practice as a Registered Nurse in the Commonwealth of Virginia
Preferred Qualifications

Prior experience working in med/surg or adult patient settings is highly desirable.

Compensation

The estimated salary for this position is $95,000 - $125,000 annually, depending on experience and qualifications.



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