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Utilization Case Manager Jobs in Virginia (NOW HIRING)

American Traveler

Travel Case Manager

Chesapeake, VA · On-site

Utilization Review (UR) experience required * Recent experience in adult acute care hospital setting with discharge planning * Rated 4/5 or 5/5 across all Case Management functions, including ...

Encompass Health

Case Manager

Bristol, VA · On-site

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health Corporation

Case Manager

Fredericksburg, VA · On-site

$19.75 - $25.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...

Encompass Health

Case Manager

Fredericksburg, VA · On-site

$19.75 - $25.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...

Encompass Health

Case Manager

Charlottesville, VA

$35/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Charlottesville, VA

$35/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Fredericksburg, VA · On-site

$19.75 - $25.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...

GQR Healthcare

Travel Case Manager

Chesapeake, VA · On-site

$2.0K - $2.1K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

VyTalent Solutions

Travel Case Manager

Chesapeake, VA · On-site

$500/wk

Utilization Review (UR) experience required. Ability to effectively manage a high-volume, fast ... Case Manager RN - Registered Nurse About VyTalent Solutions At VyTalent Solutions, we believe your ...

GQR Healthcare

Travel Case Manager

Chesapeake, VA · On-site

$2.1K - $2.2K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

RN Case Manager (Open) Full time : Monday - Friday, 8am-4:30pm Sign on bonus and relocation ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Encompass Health

Case Manager II

Aldie, VA · On-site

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Virginia

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Virginia? For Utilization Case Manager jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Virginia look for? The top searched job categories for Utilization Case Manager jobs in Virginia are:
What cities in Virginia are hiring for Utilization Case Manager jobs? Cities in Virginia with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Virginia as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

RN Case Manager - Utilization Management - Part Time

Augusta Medical Center

Fishersville, VA • On-site

$35.43 - $54.21/hr

Part-time

Medical, Retirement, PTO

Posted 7 days ago

Job description

The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on the patient care units. This position works closely with admitting and attending providers as well as the Utilization Management Physician Advisor to ensure patient status is accurate and compliant with regulatory standards. The Utilization Review RN Case Manager is viewed by clinical teams as an expert in the building when it comes to selecting the appropriate level of service for patients. They participate in multidisciplinary discharge rounds on the hospital units to understand clinical course, discharge plans and possible changes in medical necessity, all toward selecting the levels of care that match clinical necessity. This position plays an essential role in securing reimbursement to the hospital for services provided by commercial, Medicaid and Medicare payers through timely communication and submission of relevant clinical information to the payer when required. The effective tending of utilization review lowers the frequency of avoidable denials by payers for services provided. This role ensures adherence to the policies and guidelines of all payer review organizations to secure appropriate reimbursement for patient hospitalizations. During normal business hours this position may screen patients to determine if case management follow-up is required.

Minimum Qualifications

  • Bachelor of Science in Nursing
    OR
  • Associate’s degree in Nursing PLUS three years of experience as an RN
  • Registered nurse license in the Commonwealth of Virginia or from a state that is part of a compact agreement with Virginia
  • Acute care hospital experience or comparable job-related experience in at least 3 of the last 5 years

Preferred Qualifications

  • National certification in case management or utilization management preferred
  • 3 to 5 years of recent experience in utilization review and/or discharge planning in an acute care setting preferred

Skills

  • Comprehensive knowledge of regulatory, legislative, and DNV standards related to utilization review.
  • Proficient in computer skills including navigating EHRs, medical necessity criteria, Microsoft Office products.
  • Effective verbal and written skills with the ability to collaborate with multiple disciplines throughout the organization.
  • Good problem solving and decision-making skills.
  • Excellent organizational skills and the ability to work in a fast-paced environment.

Some benefits of working at Augusta Health include

  • Healthcare Benefits
  • Generous paid time off
  • Retirement savings helping you to plan for your future
  • Free onsite parking
  • 24/7 armed security to ensure your safety
  • Tuition reimbursement
  • Onsite child care
  • Augusta Health Fitness Reimbursement Program
  • Onsite credit union
  • Employee discounts including the cafeteria, gift shop, pharmacy, and movie tickets

Company Information

Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.

Equal Opportunity

Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

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