1

Anthem Utilization Review Jobs in Virginia (NOW HIRING)

Review clinical documentation and approve as needed to ensure quality and compliance. * Conduct ... Consumer-driven health plan coverage provided by Anthem * Wellness: When you enroll in a medical ...

Review clinical documentation and approve as needed to ensure quality and compliance. * Conduct ... Consumer-driven health plan coverage provided by Anthem * Wellness: When you enroll in a medical ...

Review clinical documentation and approve as needed to ensure quality and compliance. * Conduct ... Consumer-driven health plan coverage provided by Anthem * Wellness: When you enroll in a medical ...

Review clinical documentation and approve as needed to ensure quality and compliance. * Conduct ... Consumer-driven health plan coverage provided by Anthem * Wellness: When you enroll in a medical ...

Anthem Utilization Review information

See Virginia salary details

$21

$41

$68

How much do anthem utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for anthem utilization review in Virginia is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

What is an Anthem Utilization Review?

An Anthem Utilization Review job involves assessing medical services and treatments to ensure they are necessary, cost-effective, and aligned with insurance policies. Professionals in this role review patient records, apply clinical guidelines, and collaborate with healthcare providers to determine coverage eligibility. They help prevent unnecessary procedures while supporting quality patient care. This position typically requires a healthcare background, such as nursing or case management, along with knowledge of insurance regulations and medical necessity criteria.

What does an Anthem Utilization Review do?

A typical day in an Anthem Utilization Review position involves evaluating medical records and authorization requests to determine if healthcare services meet established criteria for coverage. You’ll collaborate frequently with healthcare providers, case managers, and internal teams to clarify clinical information and help guide appropriate care pathways. The job is largely desk-based and requires strong organizational skills to manage multiple concurrent cases and meet tight deadlines. Most professionals in this role work within a team structure, sharing best practices and supporting each other in making objective, evidence-based decisions. This dynamic environment offers exposure to a variety of healthcare scenarios and opportunities for ongoing learning in utilization management.

What are the key skills and qualifications needed to thrive in an Anthem Utilization Review?

To thrive as an Anthem Utilization Review professional, you need a background in nursing or healthcare, strong analytical abilities, and familiarity with medical terminology and insurance guidelines. Experience with clinical documentation systems, review software, and URAC or NCQA certifications are commonly required. Excellent communication, critical thinking, and attention to detail are crucial soft skills in this position. These capabilities ensure accurate review of medical necessity, effective collaboration with providers, and regulatory compliance, which are vital for quality patient outcomes and cost management.

What are the most commonly searched types of Anthem Utilization Review jobs in Virginia?

The most popular types of Anthem Utilization Review jobs in Virginia are:

Infographic showing various Anthem Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 93% In-person, and 7% Hybrid job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

Primary Therapist I- Adolescent Residential Care

AMFM Healthcare

Waterford, VA • On-site

$80K - $96K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago


Job description

Primary Therapist – Adolescent Residential Mental Health

Location: Waterford, VA

Schedule: Tuesday - Saturday, 10:00am-6:00pm.


Mission Prep, part of AMFM Healthcare, is seeking a compassionate and experienced Primary Therapist to join our residential adolescent treatment program. This is a fantastic opportunity to make a lasting impact on the lives of adolescents facing mental health challenges, while contributing to the success of our growing program.

In this role, you will manage a caseload of 6-8 adolescent clients and their families, providing individualized therapy for those with a range of acute mental health diagnoses. The ideal candidate will be a skilled listener, comfortable working closely with clients to understand their needs, and dedicated to helping them reach their goals.


About Mission Prep:

Mission Prep is an adolescent-focused treatment program within the AMFM Healthcare family. We aim to provide sustainable, positive change for adolescents and their families who are struggling with mental health issues. We believe in treating the entire family system, allowing families to address their children’s challenges in a supportive and sustainable way. At Mission Prep, we are committed to preparing teens for life’s challenges and offering families the fresh start they need.

Our approach blends time-tested therapeutic methods with innovative interventions to create a lasting impact that continues well after discharge. From our board-certified psychiatrists to our beautifully designed, home-like environment, we ensure that every aspect of care promotes a sense of belonging and healing.

To learn more, visit our website: Mission Prep Healthcare


Position Overview:

As a Primary Therapist, you will be responsible for providing high-quality, client-centered care through individual and group therapy, case management, and comprehensive treatment planning. You will play a key role in the healing process of adolescents and their families by delivering therapeutic interventions and ensuring that clients receive the support they need to reach their goals.

Key Responsibilities:
  • Conduct clinical evaluations, biopsychosocial assessments, and client diagnoses, along with interpretive summaries.
  • Develop and implement person-centered treatment plans, case management strategies, and provide referrals as needed.
  • Offer therapeutic interventions, including crisis counseling, for individuals, groups, and families.
  • Facilitate individual psychotherapy sessions and group therapy as part of the treatment process.
  • Provide services in accordance with organizational policies and mental health/substance abuse standards.
  • Assess individual and family systems, identifying areas in need of continued support and resources.
  • Maintain accurate and up-to-date Electronic Health Records (EHR) documenting treatment progress.
  • Collaborate with the utilization review team to provide pre-certification and concurrent reviews for insurance authorization.
  • Attend staff meetings, training, and other activities to ensure the efficient functioning of clinical operations.
  • Adhere to organizational standards, ethical practices, legal requirements, and professional standards at all times.
Qualifications and Skills:
  • Required Credentials:
    • Resident in Counseling, Supervisee in Social Work, Licensed Masters Social Worker or full independent licensure.
    • Active/current registration with the Virginia Dept of Health Professions.
  • Preferred Experience:
    • Experience with EMDR and working with adolescents in a clinical setting.
  • Education:
    • Master’s degree in a relevant field (e.g., Psychology, Social Work, Marriage and Family Therapy).
  • Technical Skills:
    • Proficiency with Electronic Medical Records (EMR) systems.
    • Strong knowledge of HIPAA regulations and a commitment to maintaining confidentiality.
  • Interpersonal Skills:
    • Strong communication, organizational, and interpersonal skills.
Work Schedule & Details:
  • Location: In-person services at our residential facility.
  • Type: Full-time, salaried position.
Benefits:
  • Medical, Dental, and Vision plans through Anthem.
  • FSA/HSA Accounts.
  • Life/AD&D insurance through Anthem, 100% employer-paid.
  • 401(k) plan with employer match.
  • Paid Time Off (PTO) and Self Care Day.
  • Educational Assistance Reimbursement Program.
  • Employee Assistance Program (EAP).
  • Health and Wellness Membership benefits.

About AMFM Healthcare:

Founded after the tragic loss of a beloved son to mental illness, A Mission for Michael (AMFM Healthcare) was established with the vision of preventing similar heartache for other families. Our mission is to provide exceptional residential mental health care that transforms lives and promotes lasting recovery.

AMFM Healthcare brings together a team of highly qualified and passionate professionals who are dedicated to providing comprehensive care for individuals with severe mental health conditions. We understand the profound impact mental illness can have on individuals and their families, and we are committed to offering support, healing, and hope.

What sets us apart is our commitment to evidence-based treatment and our relentless focus on optimizing outcomes for our residents. We continuously integrate the latest research into our care programs to ensure the highest quality of treatment.

At AMFM Healthcare, we foster a nurturing environment where individuals can find solace, healing, and a path to recovery. Our staff prioritizes compassionate, personalized care, understanding that each person’s journey with mental illness is unique.


Ready to make a difference? If you are passionate about improving the lives of adolescents and their families and want to be part of a compassionate, supportive team, apply now to join Mission Prep.




AMFM Healthcare is committed to providing equal employment opportunities to all employees and applicants without regard to race, ethnicity, religion, color, sex (including childbirth, breast feeding and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age, protected medical condition, genetic information, disability, or any other protected status in accordance with all applicable federal, state and local laws.