Utilization Review Coordinator jobs in Norfolk, VA
Utilization Review Coordinator 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 Coordinator 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 Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Recently Added Utilization Review Coordinator jobs
- Sentara
-
Norfolk, VA
FULL_TIME
-
Sentara Healthcare is seeking to hire a qualified individual to join our team as a Director, Utilization Management.
Position Status: Full-time, Day Shift
Position Location: This position is remote within our remote states.
Standard Working Hours: 8:00AM to 5:00PM (ET).
Minimum Requirements:
- Bachelor’s degree required.
- Single state RN (based on remote state) required.
- 5 years leadership experience required.
Preferred Requirements:
- Master’s degree preferred.
Expectations for this Role:
Sentara Health Plans is seeking a Director, Utilization Management supporting and facilitates continuous efforts to improve organizational and clinical performance, ensuring quality of care meets or exceeds regulatory standards and requirements as measured by division quality leaders.
Additional Expectations:
- Compliance.
- Staff retention.
- Strategy.
- Cost Effectiveness.
- Accountability.
This role will have 4 direct managers and managers will have 2 team coordinators under them.
Sentara Health Overview
Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020).
Mission, Purpose, and Values
- Mission – We improve health every day.
- Purpose – Sentara exists to be the trusted partner to individuals and the community in their journey to health and well-being.
- Values – People, Quality, Patient Safety, Service, and Integrity.
Sentara Healthcare Commitments
Sentara has made a commitment to its colleagues, patients, and members to:
- Always keep you safe.
- Always treat you with dignity, respect, and compassion.
- Always listen and respond to you.
- Always keep you informed and involved.
- Always work together as a team to provide you with quality healthcare.
Sentara Benefits
As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:- Medical, Dental, and Vision Insurance
- Paid Annual Leave, Sick Leave
- Flexible Spending Accounts
- Retirement funds with matching contribution
- Supplemental insurance policies, including legal, Life Insurance and AD&D among others.
- Work Perks program includes discounted movie and theme park tickets among other great deals.
- Opportunities for further advancement within our organization
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!Please Note: Yearly Flu Vaccination are required for employment.
#indeed, #LI-AB1
For applicants within Washington State, the following hiring range will be applied: $116,407.20 - $147,267.12.
Candidates must have residency in one of the following states to work remotely in this position:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming
Key words: Clinical Pharmacy, PBM, Director Pharmacy PBM, remote, managed care
The Director of Utilization Management (UM) is responsible for providing oversight to the daily functions of the UM staff and monitoring staff performance in accordance with Health Plan policies and procedures. Responsible for assessment, planning, implementation, coordination, monitoring and evaluation of the managed care members' performance across the continuum of care to include the complete transition of care to outpatient care. Leads special projects, reviews of UM programs, and evaluation of UM performance, as indicated by contract, regulatory and/or accreditation requirements. Collects, analyzes, audits and reports UM program trends and quality outcomes. Provides clinical and operational oversight of each UM initiative which includes analysis of clinical data to drive performance improvement. Develops, implements, and monitors policies and procedures for contract and accreditation compliance. Provides recommendations to senior leaders on healthcare strategies, product development, policy and procedure changes and/or cost control opportunities.- Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP)
- Registered Nurse (RN) Single State - Nursing License - West Virginia
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- Bachelor's Level Degree
- Master's Level Degree
- Nursing 5 years
- Managed Care 5 years
- Coordination
- Critical Thinking
- Judgment and Decision Making
- Leadership
- Learning Strategies
- Mathematics
- Mgmt of Financial Resources
- Mgmt of Material Resources
- Mgmt of Staff Resources
- Microsoft Excel
- Microsoft Word
- Monitoring
- Persuasion
- Project Management
- Quality Control Analysis
- Reading Comprehension
- Science
- Service Orientation
- Social Perceptiveness
- Speaking
- Systems Analysis
- Systems Evaluation
- Technology/Computer
- Time Management
- Troubleshooting
- Writing
- Active Learning
- Active Listening
- Communication
- Complex Problem Solving
- 5 Days Ago
- elevancehealth
-
Norfolk, VA
FULL_TIME
- Job ID: JP00044376Anticipated Start Date: 04/15/2024Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.Elevance Health is...
- 1 Month Ago
- Elevance Health
-
Norfolk, VA
FULL_TIME
- Job ID: JP00044376 Anticipated Start Date: 04/15/2024 Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date. PLEASE NOTE - Q...
- 1 Month Ago
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SWANQUARTER, NC
FULL_TIME
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- 29 Days Ago
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- 29 Days Ago
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0 Utilization Review Coordinator jobs found in Norfolk, VA area
- Ghostrock
-
Norfolk, VA
- Job Description Job Description Ghostrock, a subsidiary of Three Saints Bay, LLC, is a Federal Contracting company looki...
- 4/26/2024 12:00:00 AM
- US District Court, Norfolk.,VA
-
Norfolk, VA
- U.S. District Court Norfolk, VA Workplace Summary The United States District Court for the Eastern District of Virginia ...
- 4/25/2024 12:00:00 AM
- U.S. District Court - EDVA
-
Norfolk, VA
- U.S. District Court Norfolk, VA Workplace Summary The United States District Court for the Eastern District of Virginia ...
- 4/25/2024 12:00:00 AM
- Pennoni
-
Virginia Beach, VA
- Job Description Pennoni is a multidisciplinary consulting engineering firm founded more than five decades ago. We approa...
- 4/24/2024 12:00:00 AM
- Gables Search Group
-
Hampton, VA
- Summary Our client is looking for an experienced Project manager for heavy civil and marine construction projects such a...
- 4/24/2024 12:00:00 AM
- International Staffing Consultants, Inc.
-
Chesapeake, VA
- Summary Our client is looking for an experienced Project manager for heavy civil and marine construction projects such a...
- 4/23/2024 12:00:00 AM
- Lincoln Search Consultants
-
Chesapeake, VA
- Summary Our client is looking for an experienced Project manager for heavy civil and marine construction projects such a...
- 4/23/2024 12:00:00 AM
- Valley Care Management
-
Portsmouth, VA
- PRIMARY DUTIES AND RESPONSIBILITIES The Concierge primary duties and responsibilities include, but are not limited to: C...
- 4/23/2024 12:00:00 AM
About Norfolk, Virginia
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