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Remote Rn Utilization Review Nurse Jobs in Virginia

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, or managed care experience; or any combination of education and experience ... Current active, valid and unrestricted RN license and/or certification to practice as a health ...

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, or managed care experience; or any combination of education and experience ... Current active, valid and unrestricted RN license and/or certification to practice as a health ...

Prestige

LPN Case Manager

Richmond, VA · Remote

$75K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... utilization review * Facilitate timely and safe discharge planning * Serve as primary point of ... This is a Remote Position. * Competitive Salary * Medical, Dental, and Vision Insurance * 401K ...

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Remote Rn Utilization Review Nurse information

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$21

$41

$68

How much do remote rn utilization review nurse jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for remote rn utilization review nurse 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 is the difference between Remote Rn Utilization Review Nurse vs Remote Rn Case Manager?

AspectRemote Rn Utilization Review NurseRemote Rn Case Manager
CertificationsRN license, possibly UR or CCM certificationRN license, CCM or other case management certification
Work EnvironmentReviewing medical records, insurance guidelines, and authorizationsCoordinating patient care, discharge planning, and resource management
Employer & Industry UsageHealth insurance companies, third-party administratorsHospitals, health plans, healthcare providers

Remote Rn Utilization Review Nurses primarily evaluate medical necessity for insurance approvals, focusing on documentation and guidelines. In contrast, Remote Rn Case Managers coordinate patient care, discharge planning, and resource allocation. Both roles require RN licensure and related certifications but differ in daily tasks and work focus.

What is a Remote RN Utilization Review Nurse?

A Remote RN Utilization Review Nurse is a registered nurse who evaluates medical records and healthcare services from a remote location to ensure that patients receive appropriate, necessary, and cost-effective care. They review treatment plans, check for compliance with insurance and healthcare guidelines, and often work with healthcare providers, insurance companies, and patients to coordinate care. This role typically involves assessing the medical necessity of procedures, authorizing services, and helping prevent unnecessary treatments or hospitalizations.

What are the key skills and qualifications needed to thrive as a Remote RN Utilization Review Nurse?

To thrive as a Remote RN Utilization Review Nurse, you need an active RN license, strong clinical knowledge, and experience in case management or utilization review. Proficiency with healthcare review software, electronic health records (EHRs), and familiarity with insurance guidelines or regulatory requirements is vital. Excellent communication, critical thinking, and time management skills distinguish top performers in remote settings. These skills enable nurses to make accurate, timely decisions about patient care while ensuring compliance and efficient resource utilization.

What are some common challenges faced by Remote RN Utilization Review Nurses, and how can they be addressed?

Remote RN Utilization Review Nurses often encounter challenges such as managing large caseloads, maintaining effective communication with interdisciplinary teams, and staying updated with ever-changing insurance guidelines. Balancing productivity expectations while ensuring thorough case reviews can be demanding. To address these challenges, nurses can utilize robust organizational tools, participate in ongoing training sessions, and leverage regular virtual meetings to stay connected with colleagues and supervisors, ensuring both efficiency and high-quality patient care.

What are the most commonly searched types of Rn Utilization Review Nurse jobs in Virginia?

The most popular types of Rn Utilization Review Nurse jobs in Virginia are:

What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Virginia?

For Remote Rn Utilization Review Nurse jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Remote Rn Utilization Review Nurse jobs in Virginia look for?

The top searched job categories for Remote Rn Utilization Review Nurse jobs in Virginia are:

What cities in Virginia are hiring for Remote Rn Utilization Review Nurse jobs?

Cities in Virginia with the most Remote Rn Utilization Review Nurse job openings:

Remote Rn Utilization Review Nurse jobs near you
Infographic showing various Remote Rn Utilization Review Nurse job openings in Virginia as of August 2026, with employment types broken down into 86% Full Time, 6% Part Time, and 8% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remo

Sentara Health

Norfolk, VA • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 2 days ago. Applications are no longer accepted.

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 411 frontline employees who took The Breakroom Quiz

494th of 887 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans is hiring a Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Substance Abuse - Remote in VA and NC!
Status: Full-time, permanent position (40 hours)
Work hours: Flexible dayshift; Can start from 6am to 9am EST, M-F
Location: Fully remote in Virginia OR North Carolina.
Overview
  • Behavioral Health Utilization Management clinician is responsible for review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed.
  • Requires knowledge of medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols and clinical review requirements.
  • Requires knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers.
  • Ensures appropriate and accurate information is entered into claims system for processing of payment.

Education
  • Master's degree in Counseling, Social Work, or Marriage and Family Therapy REQUIRED
  • For Registered Nurses, a Bachelor of Science in nursing is REQUIRED

Certification/Licensure
REQUIRED license must be valid in state of practice. One of the following qualifies:
  • Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Clinical Social Worker (LCSW) - State license - North Carolina Social Work Certification and Licensure Board (NCSWCLB) OR
  • Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Professional Counselor (LPC) - State license - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) OR
  • Licensed Marriage and Family Therapist (LMFT) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Marriage and Family Therapist (LMFT) - State license - North Carolina Marriage and Family Therapy Licensure Board (NCBMFT) OR
  • Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON)OR
  • Licensed Substance Abuse Treatment Practitioner (LSATP)
  • Certified Substance Abuse Counselor (CSAC) OR Licensed Chemical Dependency Counselors (LCDC) preferred

Experience
  • 2 years of behavioral health REQUIRED
  • 1 year of case management REQUIRED
  • Experience in substance abuse in American Society of Addiction Medicine (ASAM) levels of care) and utilization management preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-104132
Talroo - Health Plan
Managed Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, Nursing, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Registered Nurse License (RN), Clinical, behavioral health, care coordination, discharge planning, continuity of care, transitions of care, Remote, Virginia, Weekends, Days, North Carolina, Licensed Substance Abuse Treatment Practitioner, LSATP,Certified Substance Abuse Counselor, CSAC, Licensed Chemical Dependency Counselors, LCDC, American Society of Addiction Medicine (ASAM)
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 ifestablished 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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