Utilization review nurse [h1.location_city]

Do you crave a career that truly makes an impact in people’s lives? Do you thrive on problem-solving and finding solutions? Join a dedicated, tight-knit team that creates an immediate and meaningful impact every day

Leidos QTC Health Services is seeking a Provider Utilization Lead to support the VA Program. You will be responsible for developing, implementing, and overseeing provider utilization strategies to ensure high-quality, cost-effective care across the network. This role analyzes utilization trends, reviews processes, and collaborates with the operations team and provider management teams to optimize resources and ensure we meet the customer metrics.

Primary Responsibilities :

• Responsible for driving strategic initiatives in collaboration with stakeholders and support teams.
• Monitor and evaluate the utilization patterns to determine the appropriate provider modalities and ensure pending exams have a quick solution.
• Utilize data to identify utilization strategies and including over and under-utilization.
• Assess provider utilization through cost, quality, and utilization metrics
• Develop a VA provider dashboard and share key metrics with Enabling Operations and VA Operations Leadership
• Work with provider management and Operations to address trends, improve efficiency, and resolve utilization concerns.
• Recommend and implement network improvements to support critical business initiatives.
• Serve as a key liaison between operations, provider management, and clinic operations
• Participate in interdisciplinary meetings and quality improvement initiatives
• Analyze large data sets to identify utilization trends, risk areas, and opportunities for improvement
• Prepare reports for leadership summarizing findings, metrics, and recommendations
• Support forecasting, planning, and performance improvement projects through data-driven insights
• Maintain documentation and audit readiness for internal and external reviews
• Preform other duties and responsibilities as assigned

Required Qualifications :

Preferred Qualifications :

Additional Information :

About Leidos QTC Health Services

Leidos QTC Health Services collaborates closely with government and non-government customers to address current and future program needs within the health services domain. We specialize in disability-focused medical examinations, independent medical exams and review services, occupational health services, diagnostic testing, and case management solutions. As innovators, we focus on advancing technologies that improve service delivery, with a particular emphasis on enhancing accessibility for examinees in rural communities. With a proven track record of continuous improvement and steady growth, we now handle over million appointments annually. Visit for more information.

Compensation and Benefits

Pay and benefits are fundamental to any career decision. That's why we craft compensation packages that reflect the importance of the work we do for our customers. As a result, we offer meaningful and engaging careers to support you and your career goals, all while nurturing a healthy work-life balance. Employment benefits include competitive compensation, Health and Wellness programs, Income Protection, Paid Leave and Retirement.

This role may fall under the Service Contract Act (SCA), a federal law which provides for a Department of Labor-prescribed minimum prevailing rate of pay and certain benefit levels. Where appropriate, Company-provided benefit plans such as comprehensive leave, holiday, medical, dental, life, accident, disability coverages, retirement plan contributions, and other health and welfare benefits and payments are utilized to meet these obligations.

Commitment to Non-Discrimination

All qualified applicants will receive consideration for employment without regard to sex, race, ethnicity, age, national origin, citizenship, religion, physical or mental disability, medical condition, genetic information, pregnancy, family structure, marital status, ancestry, domestic partner status, sexual orientation, gender identity or expression, veteran or military status, or any other basis prohibited by law. Leidos QTC Health Services will also consider for employment qualified applicants with criminal histories consistent with relevant laws.