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in Salem, VA

$32 per hour
About this job


Direct and manage the day-to-day operations of the Utilization Review department.


  • Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patients provider benefits for their needs.
  • Conducts and oversees concurrent and retrospective reviews for all patients.
  • Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process.
  • Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs.
  • Collaborates with ancillary services in order to prevent delays in services.
  • Evaluates the UM program for compliance with regulations, policies and procedures.
  • May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
  • Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.


  • Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
  • Six or more year's clinical experience with the population of the facility preferred.
  • Four or more years experience in utilization management required.
  • Three or more years of supervisoryexperience required.


  • If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.