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Insurance Utilization Review Jobs in West Virginia

Corvel

Telephonic Case Manager I

Charleston, WV · Remote

$63K - $95K/yr

Strong cost containment background, such as utilization review or managed care helpful ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Corvel

Telephonic Case Manager I

Charleston, WV · On-site

$63K - $95K/yr

Strong cost containment background, such as utilization review or managed care helpful ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Gianteagle

$16.25 - $20/hr

Ensure proper documentation for transmitting information to insurance companies, reviewing profiles for appropriate billing choices. * Alert pharmacists appropriately for drug utilization reviews ...

Gianteagle

$12 - $14.75/hr

Ensure proper documentation for transmitting information to insurance companies, reviewing profiles for appropriate billing choices. * Alert pharmacists appropriately for drug utilization reviews ...

WVU Medicine

Discharge Planner

Keyser, WV · On-site

Demonstrates working knowledge of Medicare, Medicaid, and private insurance guidelines relevant to ... Collaborates with case managers, utilization review, and third-party payors to support timely ...

WVU Medicine

Discharge Planner

Keyser, WV · On-site

Demonstrates working knowledge of Medicare, Medicaid, and private insurance guidelines relevant to ... Collaborates with case managers, utilization review, and third-party payors to support timely ...

Weis Markets

Graduate Pharmacy Intern

Rock Cave, WV · On-site

$15 - $18.50/hr

Process third-party claims and help resolve insurance-related issues. * Enter and update patient ... Perform initial drug utilization reviews and identify potential drug interactions or ...

Wexford Health Sources, Inc.

Dental and Vision insurance * 401(k) retirement saving plan * Company-paid short-term disability ... reviews of off-site care, DME utilization, provider prescriptive practice, laboratory, and x-ray ...

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Insurance Utilization Review information

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$32

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How much do insurance utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for insurance utilization review in West Virginia is $32.73, according to ZipRecruiter salary data. Most workers in this role earn between $25.87 and $37.60 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 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 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 popular job titles related to Insurance Utilization Review jobs in West Virginia? For Insurance Utilization Review jobs in West Virginia, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in West Virginia look for? The top searched job categories for Insurance Utilization Review jobs in West Virginia are:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in West Virginia as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 22% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $68,085 per year, or $32.7 per hour.

Director of Nursing

Wexford Health Sources, Inc.

Charleston, WV • On-site

$90 - $120/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Wexford Health Sources rating

6.4

Company rating: 6.4 out of 10

Based on 30 frontline employees who took The Breakroom Quiz

639th of 887 rated healthcare providers

Job description

POSITION: Director of Nursing – DON SCHEDULE: Full-time Day Shift FACILITY: South Central Regional Jail LOCATION: Charleston, WV 25309

Are you ready to lead nursing services where your leadership drives quality care and lasting impact?

Wexford Health Sources, Inc. has been a trusted leader in correctional healthcare for over 30 years, delivering patient-centered care to underserved populations. As Director of Nursing, you’ll shape the delivery of care, support your team, and ensure clinical excellence across the entire facility.

Position Summary
  • Leading the planning, development, and implementation of nursing policies, procedures, and programs in alignment with contractual and regulatory standards
  • Overseeing the delivery of patient care through the nursing process, ensuring quality, consistency, and clinical excellence
  • Coordinating orientation, in-service training, and continuing education for nursing staff
  • Managing recruitment, retention, and performance evaluation of nursing personnel
  • Developing and maintaining staff schedules to ensure appropriate coverage and continuity of care
  • Serving as a clinical resource and providing guidance to nursing staff on patient care and protocol adherence
  • Monitoring daily clinical operations, including review of outpatient and infirmary reports
  • Acting as on-call leadership for nursing-related issues and emergencies
  • Collaborating with healthcare providers, administration, and interdisciplinary teams to coordinate patient care
  • Leading and participating in committees such as Quality Assurance, Infection Control, and Utilization Review
  • Supporting quality improvement initiatives, audits, and performance evaluations to enhance patient care and workplace conditions
  • Reviewing incidents, medication errors, and discrepancies, and ensuring appropriate follow-up and reporting
  • Assisting with grievance responses and ensuring timely resolution of concerns
  • Preparing and submitting required reports, audits, and documentation to leadership

You’ll go beyond management. You’ll lead a team that delivers compassionate, structured, and high-quality care every day.

Why Work with Wexford Health?
  • Performance check-ins with annual merit increase
  • Generous paid-time-off program that combines vacation and sick leave
  • Paid holidays
  • Comprehensive health insurance through Blue Cross/Blue Shield
  • Dental and Vision insurance
  • 401(k) retirement savings plan
  • Company-paid short-term disability and life insurance
  • Non-taxed Healthcare and dependent care spending account
  • Continuing education options
  • Free CEUs
  • Pet Insurance
  • Flexible pay options including Wisely Card and PayPal
  • Discounted Tuition at University of North Alabama, Chamberlain University, Salem University, and Southern New Hampshire University
  • Partnership discounts on student loan refinancing, home/auto insurance, travel, electronics, entertainment, restaurants, health and wellness, and more!
What You’ll Need
  • Graduate from an accredited school of nursing; Associate’s Degree required, Bachelor’s Degree preferred
  • Active unrestricted Registered Nurse license in state of practice.
  • Active CPR certification.
  • Minimum of two to three (2–3) years of clinical supervisory experience; correctional experience preferred
  • Strong leadership, communication, and organizational skills
  • Ability to manage multiple priorities in a structured, fast-paced environment

Equal Opportunity Employer We celebrate diversity and welcome all qualified candidates.

Your leadership matters here. Your impact is felt in every patient interaction, every shift, every day.

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