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Insurance Utilization Review Jobs in Virginia (NOW HIRING)

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, ...

GQR

RN - Case Manager

Falls Church, VA

$2.5K - $2.6K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Falls Church ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Aids in the delivery of regulatory letters and patient notices related to insurance coverage/non ...

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Insurance Utilization Review information

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$41

$68

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:
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
Utilization - REACH Intensive ($2,500 Sign on Bonus)

Utilization - REACH Intensive ($2,500 Sign on Bonus)

New River Valley Community Services

Radford, VA • On-site

Full-time

PTO

Posted 27 days ago

New River Valley Community Services rating

4.0

Company rating: 4.0 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed to ensure quality services are provided. While working for NRVCS, you are subject to our generous PTO package, and benefits plan to best suit your needs. Come join this exciting team today!

**$2,500 Sign on Bonus**

Starting Salary: $36,524-Depending on Experience

Education/Experience Required:

  • Graduation from an accredited university with at least a bachelor's degree in psychology, counseling, social work, or a related human services field is required.
  • Virginia Board of Counseling QMHP-E status is required, QMHP-A and QMHP-C is preferred.
  • Experience in submitting and tracking authorizations for insurance payments for behavioral health services is preferred.

Additional compensation will be considered for any new employees who speak multiple languages. 

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