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Insurance Utilization Review Jobs in Virginia (NOW HIRING)

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

$26 - $35/hr

... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... Life Insurance * Flexible Spending or Health Savings Account * Generous Paid Time Off * Career ...

UHS

PHP Utilization Review Coordinator

Leesburg, VA · On-site

$64K/yr

Health insurance - Available after just 30 days. * Paid Time Off - Start earning after 90 days. * 401(k) with company match - Eligible after 30 days. The Utilization Review Coordinator assists ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

Life Insurance * Flexible Spending or Health Savings Account * Generous Paid Time Off * Career ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

New

UHS

PHP Utilization Review Coordinator

Leesburg, VA · On-site

Health insurance - Available after just 30 days. * Paid Time Off - Start earning after 90 days. * 401(k) with company match - Eligible after 30 days. The Utilization Review Coordinator assists ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

Life Insurance * Flexible Spending or Health Savings Account * Generous Paid Time Off * Career ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

Life Insurance * Flexible Spending or Health Savings Account * Generous Paid Time Off * Career ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

New

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

... reviews using the established hospital criteria. Communicates effectively with insurance companies ... utilization management. • Appeals all denials ensuring accuracy of information and effective ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

... reviews using the established hospital criteria. Communicates effectively with insurance companies ... utilization management. • Appeals all denials ensuring accuracy of information and effective ...

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...

UHS

Director of Utilization Management

Danville, VA · On-site

... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...

UHS

Director of Utilization Management

Danville, VA

... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...

UHS

Director of Utilization Management

Danville, VA

... insurance offering, a physician network and various related services located all over the U.S ... Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Virginia

Insurance Utilization Review information

See Virginia salary details

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$41

$68

How much do insurance utilization review jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for insurance 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 insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

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

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

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

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

What cities in Virginia are hiring for Insurance Utilization Review jobs?

Cities in Virginia with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 57% Full Time, and 43% Part Time. Highlights an 100% In-person job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

Clinical Coordinator - Utilization Review

Hampton, VA • On-site

Hampton-Newport News Community Services Board
Offices of Mental Health Practitioners • 501 - 1,000 employees
Learn more about Hampton-Newport News Community Services Boardexternal

$62K - $66K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 14 days ago

Job description

Clinical Coordinator - Utilization Review
Annual Salary: $62,406 - $66,000
Work Schedule: Monday - Friday 8:30 am - 5:00 pm
The Hampton-Newport News Community Services Board (CSB) is seeking a Clinical Coordinator - Utilization Review to join the Region 5 Reinvestment Initiative. This full-time position plays an important role in ensuring individuals receive timely, appropriate, and effective behavioral health services while supporting regional efforts to improve access to care and coordinate treatment placements.
The Clinical Coordinator - Utilization Review conducts utilization reviews of acute and intermediate levels of care, evaluates medical necessity and appropriateness of services, and manages behavioral health bed utilization on a daily basis. This position works closely with hospitals, treatment facilities, CSB staff, and regional partners to support timely movement to the most appropriate level of care.
Minimum Qualifications
To qualify for this position, candidates must have:
  • Master's degree in Human Services or a related field.
  • Three (3) years of experience in behavioral health, including utilization management.
Key Responsibilities
  • Conduct utilization reviews of acute and intermediate levels of care to assess medical necessity, appropriateness of treatment, and continued stay criteria.
  • Manage and monitor acute care bed availability and placements to support timely and appropriate transitions in care.
  • Conduct face-to-face assessments and gather information regarding an individual's treatment needs, progress, and current level of functioning.
  • Review treatment progress and outcomes and make recommendations regarding the most appropriate level of care.
  • Coordinate communication among hospitals, facilities, CSB staff, and regional partners regarding admissions, continued stays, discharges, and placements.
  • Provide guidance and recommendations related to acute, sub-acute, crisis stabilization, and community-based services.
  • Monitor consumer placements and assist with identifying appropriate and least restrictive treatment options.
  • Communicate findings, recommendations, and utilization concerns to appropriate stakeholders.
  • Prepare utilization reports and provide data-driven recommendations to support regional behavioral health planning and resource management.
  • Promote quality, cost-effective care while supporting timely access to appropriate services.
  • Participate in regional initiatives and activities designed to improve behavioral health system coordination and outcomes.

BENEFITS
  • Health, Vision, and Dental Insurance
  • Virginia Retirement System
  • Flexible Spending Account (FSA)
  • Life Insurance
  • 11 Paid Holidays

The selected candidate must successfully pass a criminal history fingerprint background investigation, DMV record check, Child Registry search, drug screening test and employment reference checks.

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