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Utilization Case Manager Jobs in Chesterfield, VA

Sentara Health

Nurse Case Manager

Richmond, VA

$10K/mo

Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs

Sentara

Nurse Case Manager

Richmond, VA

$10K/mo

Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs

Sentara Healthcare

Nurse Case Manager

Richmond, VA · On-site +1

Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs

Sentara

Nurse Case Manager

Richmond, VA · On-site

Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs

Sentara Health

Nurse Case Manager

Richmond, VA

$10K/mo

Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs

CVS Health

Case Manager, Registered Nurse

Richmond, VA · Remote

$54.10K - $155.54K/yr

Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care ...

Corvel

Field Case Manager II

Glen Allen, VA · On-site

$66.94K - $101.26K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Sentara

Integrated Case Manager

Richmond, VA

$10K/mo

Experience in case management, care coordination, or utilization/care review * Experience conducting clinical assessments (telephonic and/or face-to-face) * Experience supporting members with chronic ...

Elevance Health

Nurse Case Mgr Sr

Richmond, VA · On-site

$83.75K - $137.59K/yr

Nurse Case Mgr Sr Location: This role requires associates to be in-office 4 days per week ... Assists with development of utilization/care management policies and procedures, chairs, and ...

Elevance Health

Nurse Case Mgr Sr

Richmond, VA · On-site

$83.75K - $137.59K/yr

The Nurse Case Mgr Sr is responsible for care management within the scope of licensure for members ... Assists with development of utilization/care management policies and procedures, chairs, and ...

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All JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Chesterfield, VA

Utilization Case Manager information

See Chesterfield, VA salary details

$15

$34

$57

How much do utilization case manager jobs pay per hour?

As of May 28, 2026, the average hourly pay for utilization case manager in Chesterfield, VA is $34.69, according to ZipRecruiter salary data. Most workers in this role earn between $28.12 and $36.59 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

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.

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 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.

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 job categories do people searching Utilization Case Manager jobs in Chesterfield, VA look for? The top searched job categories for Utilization Case Manager jobs in Chesterfield, VA are:
What cities near Chesterfield, VA are hiring for Utilization Case Manager jobs? Cities near Chesterfield, VA with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Nurse Case Manager

Nurse Case Manager

Sentara Health

Richmond, VA

$10K/mo

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 26 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 377 frontline employees who took The Breakroom Quiz

489th of 864 rated healthcare providers

Job description

City/State
Richmond, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in Petersburg, Dinwiddie and Chester the area of Virginia
Status: Full Time (40 hrs/wk)
Shift: Day (8am-5pm)
*Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments.
Location of assessments include: Petersburg, Dinwiddie and Chester area of VA
Primary responsibilities include:
  • 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 or face-to-face 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. Ensures compliance with regulatory, accrediting and company policies and procedures
  • May assist in problem solving with provider, claims or service issues

Preferred: Private duty nursing experience and knowledgeable with ventilators in a facility or home
Education
  • Associates or Bachelors Degree in Nursing (Required)

Certification/Licensure
  • Virginia or Compact RN License (Required)

Experience
  • 3 years experience in Nursing (Required)
  • Experience in Private Duty Nursing or NICU or Experience working with Ventilators (Required)
  • Discharge planning experience (Preferred)
  • Managed Care experience (Preferred)

Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse, BSN, ADN, Private Duty, Ventilator, LinkedIn, Talroo-Nursing
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 ifestablished 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:

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