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Behavioral Health Utilization Review Jobs in Virginia

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

$26 - $35/hr

Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

Our team also works diligently to address or manage medical conditions and challenging behaviors ... Flexible Spending or Health Savings Account * Generous Paid Time Off * Career Development ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

$60 - $80/hr

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... behavioral or mental health, or other related health field required. · Two or more years of direct ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... behavioral or mental health, or other related health field required. • Two or more years of ...

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Behavioral Health Utilization Review information

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$41

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How much do behavioral health utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for behavioral health 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 a behavioral health utilization review?

A Behavioral Health Utilization Review (UR) job involves assessing the medical necessity, appropriateness, and efficiency of mental health and substance use disorder treatments. UR professionals review clinical documentation, apply insurance guidelines, and collaborate with providers to ensure patients receive appropriate care while ensuring compliance with policies and regulations. They help manage healthcare costs by preventing unnecessary services while advocating for necessary treatments. This role is common in insurance companies, hospitals, and managed care organizations. Strong knowledge of behavioral health guidelines and communication skills are essential for success.

What types of teams do behavioral health utilization review professionals typically work with, and how do they collaborate across departments?

Behavioral Health Utilization Review professionals frequently work within multidisciplinary teams that may include clinicians, case managers, claims specialists, and provider relations staff. Collaboration involves regularly reviewing patient records, discussing complex cases, and communicating with both internal and external healthcare providers to ensure appropriate levels of care are authorized. This role often requires coordination across departments to resolve authorization issues, clarify clinical information, and meet regulatory requirements. Effective teamwork is key to maintaining efficient workflows, supporting patient outcomes, and ensuring compliance with payer policies.

What are the key skills and qualifications needed to thrive in behavioral health utilization review, and why are they important?

To thrive in Behavioral Health Utilization Review, you typically need a clinical background in mental health or nursing, strong analytical abilities, and knowledge of insurance guidelines. Familiarity with medical coding, utilization management software (such as InterQual or MCG), and current behavioral health regulations is highly valued, and licensure (RN, LCSW, LPC, or similar) is often required. Attention to detail, critical thinking, effective communication, and strong organizational skills set top candidates apart. These competencies ensure accurate evaluation of medical necessity, efficient authorization processes, and collaboration with providers for optimal patient care.

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

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

What are popular job titles related to Behavioral Health Utilization Review jobs in Virginia?

For Behavioral Health Utilization Review jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Utilization Review jobs in Virginia look for?

The top searched job categories for Behavioral Health Utilization Review jobs in Virginia are:

What cities in Virginia are hiring for Behavioral Health Utilization Review jobs?

Cities in Virginia with the most Behavioral Health Utilization Review job openings:

Behavioral Health Utilization Review jobs near you
Infographic showing various Behavioral Health Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 90% In-person, and 10% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

497th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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