If you are a Registered Nurse who has strong hospital Utilization Review (UR) experience and are ready to take the next step into a leadership role, we would love to hear from you!
This position offers a hybrid schedule, with most work performed remotely, offering both flexibility and impact. In this role, you will lead a high-performing team of seven experienced UR nurses who complete daily reviews of newly admitted Observation and Inpatient charts to ensure accurate patient status assignment and complete documentation to support timely insurance reimbursement.
The team consistently maintains a low denial rate, reflecting their expertise and collaboration. As UR Manager, you will also stay hands-on by managing a partial review assignment using the Xsolis/Dragonfly system, while participating in higher-level meetings such as Two-Midnight and denial review discussions. You’ll work closely with a supportive and engaged physician group through Med-Metrix and our internal medical director team. Reviews span all patient populations, from short stay and ICU to behavioral health units, making this a dynamic and rewarding leadership opportunity.
Come join a hospital dedicated to you and your career!
VHC Health is a 453-bed not-for-profit Hospital and teaching facility that has been delivering high quality care to the Washington, DC metropolitan area for over 75 years. Recent accomplishments include recognition by Newsweek as a 2025 "World's Best Hospital" and VHC becoming the Washington Commanders Football provider for women's health. VHC Health is a designated Level II Trauma Center and a recognized Magnet Facility by the American Nurses Credentialing Center. At VHC Health, we are always striving to provide continued excellence and growth for our employees as well as top notch care for our patients and that is made clear with our recent accomplishments!
Purpose & Scope:
The Utilization Review Manager oversees the utilization review process, ensuring efficient and effective use of hospital resources, compliance with regulatory requirements, and optimal patient care. The Utilization Review Manager will:
Manage the utilization review team and processes.
Conduct reviews of patient care and resource utilization.
Collaborate with healthcare providers and hospital staff.
Ensure compliance with regulatory requirements and accreditation standards.
Analyze data to identify trends and opportunities for improvement.
Develop and implement strategies to optimize resource utilization and patient care.
Education:
Bachelor's of Nursing is required
Experience:
Three (3) years Utilization Review management experience; hospital and/or insurance considered.
Certification/Licensure:
Licensed as a Registered Nurse with the Virginia Department of Health Professions is required, or,
Compact State Nursing License is required.
Pay & Benefits: Commensurate with experience. Team members are eligible to receive benefits on the first day of the month following the date of hire, with 30 days to apply for benefits of choice.