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Remote Utilization Review Jobs in Virginia (NOW HIRING)

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 ...

Prestige

LPN Case Manager

Richmond, VA · Remote

$75K/yr

... 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 ...

Sentara Health

Benefits Coding Analyst

Richmond, VA · Remote

$10K/mo

This position is remote however, candidates must be able to commute to our Richmond location. The ... benefit and utilization review policies and criteria for emerging treatments, technology ...

McGuireWoods LLP

Director, Benefits

Richmond, VA · On-site +1

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

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 ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

Centerbrite

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

Centerbrite Health

BCBA

Fairfax, VA · On-site +1

$90K - $110K/yr

Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ... Remote and in-clinic Job Types: Full-time

Sentara Healthcare

Authorization Coordinator

Norfolk, VA · On-site +1

$18 - $22.25/hr

... Review, Utilization Management, Diagnostic Imaging experience, Milliman Benefits: Caring For Your ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Virginia

Remote Utilization Review information

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$41

$68

How much do remote utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for remote utilization review 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 review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

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

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

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

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

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

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

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

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

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

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

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 67% Full Time, and 33% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

499th of 898 rated healthcare providers

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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