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Entry Level Utilization Review Nurse Jobs in Virginia

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

$26 - $35/hr

... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job ... review organization, when necessary. • Graduation from an approved/accredited school of nursing ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Education/Requirements: • Graduation from an approved/accredited school of nursing or a Bachelor ...

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

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All JobsUtilization Review Nurse JobsEntry Level Utilization Review Nurse JobsEntry Level Utilization Review Nurse Jobs in Virginia

Entry Level Utilization Review Nurse information

See Virginia salary details

$21

$41

$68

How much do entry level utilization review nurse jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for entry level utilization review nurse 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 entry level utilization review nurse?

An Entry Level Utilization Review Nurse is a registered nurse (RN) who is new to the field of utilization review. Their main responsibilities include assessing medical records, ensuring that patients receive appropriate and necessary care, and verifying that health services are delivered according to established guidelines and insurance requirements. They typically work for hospitals, insurance companies, or managed care organizations and collaborate with healthcare providers to support quality patient outcomes while managing costs. This role often serves as a stepping stone to more advanced positions in healthcare administration or case management.

What are the key skills and qualifications needed to thrive as an entry level utilization review nurse, and why are they important?

To thrive as an Entry Level Utilization Review Nurse, you need a registered nurse (RN) license, knowledge of clinical guidelines, and an understanding of healthcare regulations. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are often beneficial. Strong analytical thinking, attention to detail, and effective communication skills help you review cases accurately and collaborate with providers. These skills ensure appropriate care decisions, compliance with payer requirements, and optimal patient outcomes.

What are some common challenges faced by entry level utilization review nurses, and how can they overcome them?

Entry level Utilization Review Nurses often encounter challenges such as adapting to complex insurance policies, learning to review medical records efficiently, and communicating effectively with physicians and case managers. To overcome these challenges, new nurses should seek mentorship from experienced colleagues, participate in ongoing training sessions, and familiarize themselves with the organization's review protocols and documentation systems. Building strong communication skills and staying up to date with regulatory changes will also help in navigating the learning curve and ensuring successful case reviews.

What is the difference between Entry Level Utilization Review Nurse vs Utilization Review Nurse?

AspectEntry Level Utilization Review NurseUtilization Review Nurse
CredentialsRN license, possibly some certificationRN license, often with additional certifications
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, healthcare organizations
Job ResponsibilitiesAssist in reviewing patient cases, gather data, support senior staffEvaluate medical necessity, review patient records, make coverage decisions

The Entry Level Utilization Review Nurse typically supports the more experienced Utilization Review Nurse by gathering information and assisting in case reviews. Both roles require an RN license and work within healthcare or insurance settings, but the entry-level position involves more support tasks, while the Utilization Review Nurse makes critical coverage decisions.

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

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

What are popular job titles related to Entry Level Utilization Review Nurse jobs in Virginia?

For Entry Level Utilization Review Nurse jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Entry Level Utilization Review Nurse jobs in Virginia look for?

The top searched job categories for Entry Level Utilization Review Nurse jobs in Virginia are:

What cities in Virginia are hiring for Entry Level Utilization Review Nurse jobs?

Cities in Virginia with the most Entry Level Utilization Review Nurse job openings:

Entry Level Utilization Review Nurse jobs near you
Infographic showing various Entry Level Utilization Review Nurse job openings in Virginia as of August 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 80% In-person, and 20% 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

This job post has expired today. Applications are no longer accepted.

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 416 frontline employees who took The Breakroom Quiz

499th of 896 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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