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Remote Utilization Management Jobs in Virginia (NOW HIRING)

State of Virginia

Case Intake Manager

Henrico, VA · Remote

$87K - $115K/yr

Ability to interpret and analyze complex data, including effective utilization of work productivity ... file management and queries). Must be willing to perform mobile work and to maintain a remote ...

VivSoft Technologies LLC

Program Manager

Falls Church, VA · On-site +1

$100K - $127K/yr

Program Manager Location: Remote Clearance Required: Public Trust Clearance Position Type ... Provide recommendations on resource utilization, workload distribution, and workflow optimization.

SOSi

DoD SkillBridge Logistics Manager

Reston, VA · On-site +1

In this role, you will gain valuable insight in the areas of logistics management, transportation ... utilization of logistics support services. Responsibilities: * Foster a team-oriented work ...

Maximus

Consultant - Medical (Case Reviewer 2)

VA · On-site +1

This is a remote opportunity. The Consultant will review WCMSA case submissions in support of the ... by management. Minimum Requirements - Bachelor's degree with 3-5 years of experience consulting ...

Centerbrite Health

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Carry and manage a client caseload , serving as the clinical standard-bearer for the organization

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Remote Utilization Management information

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

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

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

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 Remote Utilization Management jobs in Virginia?

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

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

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

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

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

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Integrated Case Manager- RN

Sentara Healthcare

Winchester, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

Sentara Health rating

6.7

Company rating: 6.7 out of 10

Based on 412 frontline employees who took The Breakroom Quiz

530th of 887 rated healthcare providers

Job description

City/State
Winchester, VA
Work Shift
First (Days)
Overview:
Sentara Health is looking to hire an Integrated Case Manager, RN.
Status: Full Time (40 hrs/wk)
Shift: Day (8am-5pm)
ThisPosition is remote but does require in person face-to-face assessments . Candidates must be able to travel to Winchester, Leesburg, Alexandria, Arlington, Manassas, Warrenton, Front Royal, Harrisonburg ,VA
The Integrated Case Manager is responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Performs telephonic clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services.
Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team. Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs. Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans. Presents cases at case conferences for multidisciplinary focus. Ensure compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues.
Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Education:
  • Associates
  • Bachelors preferred

Certification:
  • Registered Nurse required

Experience:
  • 3 years of nursing experience required
  • Managed care preferred
  • Discharge planning experience preferred

Keywords: Talroo- Health, Case Management, Managed Care, Discharge Planning
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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