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Therapy Utilization Review Jobs in Virginia (NOW HIRING)

UHS

UTILIZATION COORDINATOR

Danville, VA

... review and respond to concerns expressed by customers. Together with the appropriate Department ... with families, payors, therapists and physicians both verbally and in writing. Must also ...

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...

UHS

UR COORDINATOR

Danville, VA · On-site

$26 - $35/hr

... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... with families, payors, therapists and physicians both verbally and in writing. Must also ...

August Iliff

Physical Therapist

Dunn Loring, VA · On-site

$45 - $58/hr

... and utilization review meetings • Educate residents, families, and staff on therapy goals and plans • Maintain productivity and documentation standards • Support regulatory compliance and ...

August Iliff

Physical Therapist

Dunn Loring, VA · On-site

$1.6K - $2.1K/wk

... and utilization review meetings • Educate residents, families, and staff on therapy goals and plans • Maintain productivity and documentation standards • Support regulatory compliance and ...

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All JobsTherapy Utilization Review JobsTherapy Utilization Review Jobs in Virginia

Therapy Utilization Review information

See Virginia salary details

$15

$31

$53

How much do therapy utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for therapy utilization review in Virginia is $31.67, according to ZipRecruiter salary data. Most workers in this role earn between $22.16 and $40.29 per hour, depending on experience, location, and employer.

What is the difference between Therapy Utilization Review vs Speech-Language Pathologist?

AspectTherapy Utilization ReviewSpeech-Language Pathologist
CredentialsTypically requires healthcare or insurance-related certificationsRequires a master's degree in speech-language pathology and state licensure
Work EnvironmentInsurance companies, healthcare organizations, or utilization review departmentsHospitals, clinics, schools, or private practice
Industry UsageFocuses on evaluating therapy necessity and coverageProvides direct therapy services to patients with speech or language disorders

While Therapy Utilization Review involves assessing the necessity of therapy services for insurance coverage, Speech-Language Pathologists provide direct patient care. Both roles require healthcare knowledge, but they differ in focus: one is review-based, the other is clinical service delivery.

What are some common challenges faced by professionals in therapy utilization review, and how can they be managed?

One of the main challenges in Therapy Utilization Review is balancing the clinical needs of patients with insurance guidelines and organizational policies. Professionals often need to make difficult decisions about treatment approvals while communicating effectively with both therapists and insurance providers. Staying current on clinical guidelines, maintaining strong documentation skills, and developing firm but empathetic communication abilities can help manage these challenges. Collaboration with interdisciplinary teams is also essential to ensure patients receive appropriate care while meeting regulatory requirements.

What is therapy utilization review?

Therapy Utilization Review is a process used by healthcare organizations and insurance companies to evaluate the necessity, efficiency, and appropriateness of therapy services being provided to patients. This review ensures that treatments such as physical, occupational, or speech therapy are medically necessary and align with established guidelines. The goal is to optimize patient care while managing costs and preventing overuse or misuse of therapy services. Professionals in this role review patient records, treatment plans, and progress notes, often collaborating with therapists and other healthcare providers.

What are the key skills and qualifications needed to thrive as a therapy utilization review specialist?

To thrive as a Therapy Utilization Review specialist, you need a solid background in clinical therapy practice (such as physical, occupational, or speech therapy), often supported by licensure and clinical experience. Familiarity with medical review software, electronic health records (EHRs), and utilization management systems is typically required, along with knowledge of insurance guidelines and regulatory standards. Strong analytical thinking, attention to detail, and clear communication skills help professionals effectively assess treatment plans and collaborate with both providers and payers. These skills and qualities are essential for ensuring that patients receive medically necessary, cost-effective therapy while maintaining compliance with regulations.
What are popular job titles related to Therapy Utilization Review jobs in Virginia? For Therapy Utilization Review jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Therapy Utilization Review jobs in Virginia look for? The top searched job categories for Therapy Utilization Review jobs in Virginia are:
Therapy Utilization Review jobs near you
Infographic showing various Therapy Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $65,866 per year, or $31.7 per hour.

Clinical Authorization Specialist (Utilization Review)

HALLMARK YOUTHCARE RICHMOND INC

Richmond, VA • On-site

Other

Medical, Retirement

Posted 26 days ago

Job description

As a leading Residential Treatment Center in the Greater Richmond area, Hallmark Youthcare treats adolescents with emotional and behavioral challenges triggered by trauma. Treatment is provided in a warm and friendly environment by a group of well-trained, highly motivated staff that take pride in delivering quality care in a fast-paced environment.

We are seeking a detail-oriented Clinical Authorization Specialist (Utilization Review) to join our healthcare team. The ideal candidate will have experience in prior authorizations, insurance verification, utilization review, and medical necessity determinations. This role is responsible for ensuring that medical services are appropriately authorized, clinically supported, and compliant with payer guidelines before, during, and after patient care.

The Clinical Authorization Specialist serves as a liaison between healthcare providers, insurance companies, and patients to facilitate timely approvals while minimizing denials and delays in care.

In addition, this role maintains communication with referral sources (CSA/FAPT/IACCT) to coordinate placement and reimbursement standards for transfers from emergency placements and document submission to Magellan for Medicaid consideration.  

Key Responsibilities
  • Master's degree in health services field.
  • Review and process prior authorization requests for medical procedures, diagnostic testing, medications, therapies, and specialty services.
  • Evaluate clinical documentation to determine medical necessity using payer guidelines, evidence-based criteria, and insurance policies.
  • Perform prospective, concurrent, and retrospective utilization reviews.
  • Communicate with physicians, nurses, case managers, and insurance representatives to obtain required clinical documentation.
  • Submit authorization requests and monitor status through payer portals and electronic health record (EHR/EMR) systems.
  • Track authorization approvals, denials, appeals, and expiration dates to ensure continuity of care.
  • Identify incomplete or missing documentation and coordinate with providers to obtain necessary information.
  • Maintain accurate records of all authorization activities, communications, and determinations.
  • Stay current on payer policies, CMS regulations, and utilization management best practices.
  • Assist with appeals and peer-to-peer review coordination when necessary.
  • Meet productivity, turnaround time, quality, and compliance standards.

Required Qualifications

  • High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
  • Minimum of 2 years of experience in prior authorization, utilization review, medical insurance, case management, including admissions.
  • Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Experience working with electronic medical records (EMR/EHR) and payer authorization portals.
  • Excellent organizational, analytical, and problem-solving skills.
  • Strong verbal and written communication abilities.
  • Ability to prioritize multiple tasks in a fast-paced healthcare environment.

Benefits:

Set schedule Monday- Friday 9 am- 5pm

Full benefit package available

Matching 401K 

Time off accrued each payroll

Free employee meals

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