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Manager Utilization Management Jobs in Virginia (NOW HIRING)

Inova

Registered Nurse Case Manager

Falls Church, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

Inova

Registered Nurse Case Manager

Falls Church, VA · On-site

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

Inova

Registered Nurse (RN) Case Manager

Fairfax, VA · On-site

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

Inova

Registered Nurse (RN) Case Manager

Fairfax, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

Elevance Health

Medical Management Specialist I

Norfolk, VA · On-site

$19.66 - $31.04/hr

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: * Requires a H.S. diploma or equivalent ...

Elevance Health

Medical Management Specialist I

Norfolk, VA · On-site

$19.66 - $31.04/hr

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: * Requires a H.S. diploma or equivalent ...

Elevance Health

Medical Management Specialist I

Roanoke, VA · On-site

$19.66 - $31.04/hr

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: * Requires a H.S. diploma or equivalent ...

Elevance Health

Medical Management Specialist I

Roanoke, VA · On-site

$19.66 - $31.04/hr

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: * Requires a H.S. diploma or equivalent ...

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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 Jul 16, 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 are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

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 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 some common challenges faced by a Manager in 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 does a Manager of 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 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 July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $90,231 per year, or $43.4 per hour.
Manager, Managed Care Contracting

Manager, Managed Care Contracting

Sentara Healthcare

Virginia Beach, VA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Sentara Health rating

6.9

Company rating: 6.9 out of 10

Based on 392 frontline employees who took The Breakroom Quiz

449th of 886 rated healthcare providers

Job description

City/State
Virginia Beach, VA
Work Shift
First (Days)
Overview:
Manager, Managed Care Contracting
The Manager, Managed Care leads medical and pharmacy managed care contracting strategies and activities for assigned third-party payors, supporting Sentara Healthcare provider divisions. This role partners with clinical, pharmacy, and managed care leadership to optimize reimbursement, ensure contract performance, and align financial and operational objectives. The Manager, Managed Care serves as the primary liaison for a portfolio of payor relationships, overseeing contract implementation, issue resolution, and ongoing performance. This role supports data analysis and facilitates coordination of day-to-day managed care operations, including patient access, claims adjudication, and care management.
Hybrid position at 1300 Sentara Park, Virginia Beach, Virginia --two days remote and three days on site at Sentara Park.
There is an opportunity for Richmond (Virginia) residents to work same schedule at Sentara Health Plan in Richmond. Required to work each Wednesday at Sentara Park, Virginia Beach.
Education
  • Bachelor's degree (Required)

Experience
  • 3 years of experience in managed care contracting (Required)

  • 3 years of experience in healthcare (Required)

We are seeking demonstrated experience in pharmacy managed care, including:
  • Understanding of pharmacy benefit management (PBM) structures and reimbursement models (e.g., AWP, MAC, NADAC)

  • Experience negotiating pharmacy reimbursement terms and specialty pharmacy agreements

  • Knowledge of formulary management, utilization management, and drug pricing strategies

Strong financial acumen with experience in contract modeling and reimbursement analysis
Knowledge of healthcare regulations, payor requirements, and value-based care arrangements preferred
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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