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Director Utilization Management Jobs in Virginia

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

UHS

Director of Utilization Management

Danville, VA · On-site

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

UHS

Director of Utilization Management

Danville, VA

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

UHS

Director of Utilization Management

Danville, VA

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

UHS

Director of Utilization Management

Danville, VA · On-site

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

UHS

Director of Utilization Management

Danville, VA · On-site

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

Sentara Health

Anesthesiology Physician

Suffolk, VA · On-site

$380K/yr

Physician Advisor, Physician Executive, Medical Director, Utilization Management, Utilization Review, Medical Necessity Review, Clinical Documentation Integrity (CDI), Denials Management, Appeals ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

$60 - $80/hr

Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... of direct clinical experience in a psychiatric or mental health setting required. · Current ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... direct clinical experience in a psychiatric or mental health setting required. • Current ...

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All JobsUtilization Management JobsDirector Utilization Management JobsDirector Utilization Management Jobs in Virginia

Director Utilization Management information

See Virginia salary details

$17.8K

$51.9K

$83.3K

How much do director utilization management jobs pay per year?

As of Sep 5, 2026, the average yearly pay for director utilization management in Virginia is $51,873.00, according to ZipRecruiter salary data. Most workers in this role earn between $39,700.00 and $59,500.00 per year, depending on experience, location, and employer.

What is a director utilization management?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the typical daily responsibilities of a director utilization management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.

What are the key skills and qualifications needed to thrive in the director utilization management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What does a director of utilization management do?

A director of utilization management oversees the review and approval of healthcare services to ensure they are medically necessary and cost-effective. They develop policies, manage teams of reviewers, and collaborate with healthcare providers and insurance companies to optimize patient care and resource utilization.

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

The most popular types of Utilization Management jobs in Virginia are:

What are popular job titles related to Director Utilization Management jobs in Virginia?

For Director Utilization Management jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Director Utilization Management jobs in Virginia look for?

The top searched job categories for Director Utilization Management jobs in Virginia are:

What cities in Virginia are hiring for Director Utilization Management jobs?

Cities in Virginia with the most Director Utilization Management job openings:

Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 20% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $51,873 per year, or $24.9 per hour.

Senior Consultant - Clinical Utilization Management SME

Tria Federal

Arlington, VA • On-site

Other

Medical, Life

Posted 3 days ago

New

Job description

Who we are:

Tria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members and civilians. For two decades, federal agencies have relied on Tria companies to advance their critical missions and modernize their systems, so that they can uphold their commitment to the American people. Today, we are pushing the boundaries of possibility through partnerships and investments in artificial intelligence and emerging technologies, developing solutions for the biggest challenges that government will face tomorrow.

We are proud to employ and support military veterans who bring mission-first mindset, technical expertise, and leadership qualities that strengthen our work. Veterans, transitioning service members, and military spouses are strongly encouraged to apply.

Tria Federal is seeking a Senior Consultant - Clinical Utilization Management SME to provide clinical and utilization-management expertise supporting the Department of Veterans Affairs. The SME will apply utilization-management expertise to assess clinical processes, medical-necessity workflows, referral and authorization processes, care coordination, utilization patterns, and clinical risk.

The ideal candidate is a licensed RN (or other clinical degree / license) with significant experience in utilization management, care management, prior authorization, clinical review, medical necessity, appeals, care coordination, or payer/provider clinical operations.

Responsibilities:
  • Provide clinical subject matter expertise in utilization management, care management, medical necessity, and clinical review.
  • Assess referral, authorization, utilization-management, and care-coordination workflows and identify barriers to timely care.
  • Review clinical and operational processes for opportunities to improve access, quality, appropriateness, cost, and patient outcomes.
  • Evaluate utilization trends and identify clinical, operational, and process drivers of variation.
  • Support development and refinement of clinical workflows, protocols, decision support, and standard operating procedures.
  • Conduct clinical root-cause analysis involving access, utilization, care coordination, denials, medical documentation, and patient-care impacts.
  • Support evaluation of utilization-management practices across providers.
  • Develop clinical recommendations and executive-level analyses that clearly articulate patient-care, operational, financial, and compliance impacts.
  • Collaborate with physicians, nurses, healthcare administrators, network teams, payment SMEs, and VA stakeholders.
  • Support clinical requirements development, operational readiness, implementation, training, and change-management activities.
  • Contribute to assessments, white papers, decision papers, risk analyses, and performance frameworks.
Skills & Experience:
  • 7+ years of healthcare clinical operations, utilization management, care management, case management, clinical review, or related experience.
  • 3+ years of direct utilization-management or clinical review experience preferred.
  • Experience with medical necessity review, prior authorization, concurrent review, retrospective review, appeals, or care management.
  • Understanding of healthcare payer/provider workflows and clinical documentation.
  • Ability to translate clinical findings into operational and executive recommendations.
  • Strong written and verbal communication skills.
  • Bachelor's degree required; BSN preferred.
Qualifications:
  • Active, unrestricted Registered Nurse (RN) license.
  • Medicare Advantage, Medicaid, commercial payer or government payer experience.
  • InterQual, MCG/Care Guidelines, or comparable clinical decision-support experience.
  • Utilization-management accreditation or quality experience.
  • Population health/care management.
  • Behavioral health, post-acute care, specialty care, emergency care, or high-cost/high-risk population experience.
  • VA/VHA experience.
  • CCM, ACM, CPHQ, or similar certification.

Why Tria?
What defines the Tria brand is more than just our dedication to excellence in our craft; it's our incredible team of dedicated, talented, and passionate people that make Tria so exceptional. As people powering possible, we are all partners in our team's shared success.


As a company that cares about people, we seek to cultivate a culture in which all can thrive personallyandprofessionally. We offer a top-tier benefits package to invest in your physical, mental, and financial health and wellness so that you can be your best self - at workand in life. At Tria, we are growth-minded, entrepreneurial in spirit, and committed to fostering a culture of inclusion and opportunity for all. Whatever your background, your role, your department, or stage in your professional journey, here you will have opportunities to learn new skills, seize new challenges, and advance your career as we grow.

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