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Insurance Utilization Review Jobs in Virginia (NOW HIRING)

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 Assistant

Williamsburg, VA · On-site

Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources. Roles and Responsibilities: • Assists the admissions ...

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How much do insurance utilization review jobs pay per hour?

As of Jun 17, 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 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.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

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 is an Insurance Utilization Review job?

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 most commonly searched types of Insurance Utilization Review jobs in Virginia? The most popular types of Insurance Utilization Review jobs in Virginia are:
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:
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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
Clinical Coordinator - Utilization Review

Clinical Coordinator - Utilization Review

Hampton-Newport News Community Services Board

Hampton, VA • On-site

$62K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 4 days ago

Job description

Clinical Coordinator - Utilization Review

Annual Salary: $62,406

Work Schedule: Monday - Friday 8:30 am - 5:00 pm

The Hampton - Newport News Community Services Board (CSB) is hiring a Clinical Coordinator - Utilization Review for the Region 5 Reinvestment Initiative. This full-time Clinical Coordinator - Utilization Review is responsible for conducting clinical reviews of acute and intermediate care for clinical necessity and appropriateness of care and for managing utilization of beds on a daily basis to ensure movement in a clinically appropriate and expeditious manner. Major duties will include conducting clinical reviews, acute care bed management, and communication of findings and recommendations between hospitals, facilities, and CSB staff. This position will report to the Project Director of the Region 5 Reinvestment Initiative.

ROLE SUMMARY

The Clinical Coordinator (Utilization Review) ensures individuals receive the most appropriate and effective behavioral health services by conducting clinical reviews of acute care and crisis stabilization admissions. Evaluates medical necessity, monitors continued stay criteria, and makes recommendations regarding the most appropriate level of care. Working closely with hospitals, Community Services Board (CSB) staff, and regional partners, coordinates communication, tracks consumer placements, and provides clinical guidance to support informed treatment and placement decisions. Responsibilities include conducting face-to-face assessments, monitoring treatment progress and outcomes, promoting quality and cost-effective care, and preparing regular utilization reports with recommendations for acute, sub-acute, or community-based services. This position plays a critical role in ensuring consumers receive timely, clinically appropriate, and least restrictive treatment options while supporting regional behavioral health initiatives.

To qualify for this position, candidates must have:

  • Master's degree in Human Services.
  • Three (3) years of experience in behavioral health, including utilization management.

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.


Job Posted by ApplicantPro