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Remote Utilization Management Nurse Jobs in Virginia

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Elevance Health

Med Mgmt Nurse (contract)

Richmond, VA · Remote

... utilization review, or managed care experience; or any combination of education and experience ... Prefer candidates who hold an active compact license and reside in a compact state * 100% Remote ...

UVA Health

Physician Advisor (Remote)

Manassas, VA · Remote

$250K - $350K/yr

Physician Advisor (Remote) Opportunity UVA Health is seeking an experienced Physician Advisor to provide physician leadership across Utilization Management (UM), Clinical Documentation Integrity (CDI ...

Sentara Healthcare

Authorization Coordinator

Norfolk, VA · On-site +1

$18 - $22.25/hr

... (required) Experience: * 3 years of related experience (required) * Utilization Management ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Sentara Healthcare

Sentara Health is looking to hire a Behavior Health Utilization Management Care Coordinator ... This position requires both in-person/face-to-face assessments and remote telephonic assessments ...

Prestige

LPN Case Manager

Richmond, VA · Remote

$75K/yr

Monitor length of stay and levels of care to ensure appropriate resource utilization * Maintain ... This is a Remote Position. * Competitive Salary * Medical, Dental, and Vision Insurance * 401K ...

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$68

How much do remote utilization management nurse jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for remote utilization management 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 a remote utilization management nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What does a remote utilization management nurse do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

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

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by remote utilization management nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.

What is the difference between Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

More about Remote Utilization Management Nurse jobs

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

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

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

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

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

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

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

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

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

UTILIZATION REVIEW NURSE

Norfolk, VA • On-site, Remote

Sentara Healthcare
Hospitals • 10K+ employees

6.8

Company rating: 6.8 out of 10

Based on 416 frontline employees who took The Breakroom Quiz

499th of 896 rated healthcare providers

People enjoy working here

Recommended by students

Good schedule notice

Learn more about Sentara Healthcareexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

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

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
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
• 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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