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Manager Utilization Management Jobs in Virginia (NOW HIRING)

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Virginia

Manager Utilization Management information

See Virginia salary details

$38.7K

$90.2K

$166.1K

How much do manager utilization management jobs pay per year?

As of Aug 25, 2026, the average yearly pay for manager utilization management in Virginia is $90,231.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,000.00 and $108,600.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

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

The most popular types of Utilization Management jobs in Virginia are:

What are popular job titles related to Manager Utilization Management jobs in Virginia?

For Manager Utilization Management jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Virginia look for?

The top searched job categories for Manager Utilization Management jobs in Virginia are:

What cities in Virginia are hiring for Manager Utilization Management jobs?

Cities in Virginia with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Virginia as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $90,231 per year, or $43.4 per hour.

RN Case Manager - Utilization Management - Part Time

Fishersville, VA • On-site

Augusta Medical Center
1 - 5K employees
Learn more about Augusta Medical Centerexternal

$35.43 - $54.21/hr

Part-time

Medical, Retirement, PTO

Posted 19 days ago

Job description

The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on the patient care units. This position works closely with admitting and attending providers as well as the Utilization Management Physician Advisor to ensure patient status is accurate and compliant with regulatory standards. The Utilization Review RN Case Manager is viewed by clinical teams as an expert in the building when it comes to selecting the appropriate level of service for patients. They participate in multidisciplinary discharge rounds on the hospital units to understand clinical course, discharge plans and possible changes in medical necessity, all toward selecting the levels of care that match clinical necessity. This position plays an essential role in securing reimbursement to the hospital for services provided by commercial, Medicaid and Medicare payers through timely communication and submission of relevant clinical information to the payer when required. The effective tending of utilization review lowers the frequency of avoidable denials by payers for services provided. This role ensures adherence to the policies and guidelines of all payer review organizations to secure appropriate reimbursement for patient hospitalizations. During normal business hours this position may screen patients to determine if case management follow-up is required.

Minimum Qualifications

  • Bachelor of Science in Nursing
    OR
  • Associate’s degree in Nursing PLUS three years of experience as an RN
  • Registered nurse license in the Commonwealth of Virginia or from a state that is part of a compact agreement with Virginia
  • Acute care hospital experience or comparable job-related experience in at least 3 of the last 5 years

Preferred Qualifications

  • National certification in case management or utilization management preferred
  • 3 to 5 years of recent experience in utilization review and/or discharge planning in an acute care setting preferred

Skills

  • Comprehensive knowledge of regulatory, legislative, and DNV standards related to utilization review.
  • Proficient in computer skills including navigating EHRs, medical necessity criteria, Microsoft Office products.
  • Effective verbal and written skills with the ability to collaborate with multiple disciplines throughout the organization.
  • Good problem solving and decision-making skills.
  • Excellent organizational skills and the ability to work in a fast-paced environment.

Some benefits of working at Augusta Health include

  • Healthcare Benefits
  • Generous paid time off
  • Retirement savings helping you to plan for your future
  • Free onsite parking
  • 24/7 armed security to ensure your safety
  • Tuition reimbursement
  • Onsite child care
  • Augusta Health Fitness Reimbursement Program
  • Onsite credit union
  • Employee discounts including the cafeteria, gift shop, pharmacy, and movie tickets

Company Information

Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.

Equal Opportunity

Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

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