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Utilization Management Assistant Jobs in Virginia

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Coordinates, performs, and monitors all utilization review/management activities of the hospital to ... Provides information to physicians to assist them in their role in appeals. • Assists the ...

UHS

UTILIZATION COORDINATOR

Danville, VA · On-site

... and payor and managing timely transitions through the phases of residential care. Key ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

Evolent

Radiology Physician

Arlington, VA

$368K - $460K/yr

May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. * Participates in on-going ...

Evolent

Internal Medicine Physician

Arlington, VA

May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. * Participates in on-going ...

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All JobsUtilization Management JobsUtilization Management Assistant JobsUtilization Management Assistant Jobs in Virginia

Utilization Management Assistant information

See Virginia salary details

$28.8K

$48K

$68.9K

How much do utilization management assistant jobs pay per year?

As of Jul 26, 2026, the average yearly pay for utilization management assistant in Virginia is $47,981.00, according to ZipRecruiter salary data. Most workers in this role earn between $41,600.00 and $48,100.00 per year, depending on experience, location, and employer.

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

To thrive as a Utilization Management Assistant, you need a solid understanding of healthcare processes, medical terminology, and administrative procedures, often supported by a high school diploma or associate's degree. Familiarity with electronic health records (EHR) systems, insurance verification tools, and Microsoft Office Suite is typically required. Strong organizational skills, attention to detail, and effective communication are crucial soft skills for managing documentation and collaborating with clinical teams. These skills ensure accurate data handling, efficient workflow, and compliance with healthcare regulations, all of which are vital for successful utilization management operations.

What are some common challenges Utilization Management Assistants face when working with insurance pre-authorizations?

Utilization Management Assistants often encounter challenges such as navigating complex insurance requirements, meeting tight deadlines for pre-authorization requests, and communicating effectively with both healthcare providers and insurance representatives. Staying organized and detail-oriented is essential to ensure all documentation is accurate and submitted promptly. Additionally, adapting to frequent changes in insurance policies and maintaining strong problem-solving skills are key to overcoming these obstacles.

What is a Utilization Management Assistant?

A Utilization Management Assistant is a healthcare administrative professional who supports the utilization management team by handling clerical tasks, coordinating communications, and organizing patient documentation. They often help ensure that medical services are used efficiently and that insurance requirements are met by gathering information, processing authorizations, and maintaining records. This role is essential in facilitating collaboration between healthcare providers, insurance companies, and patients, ultimately helping to optimize the quality and cost-effectiveness of patient care.
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 cities in Virginia are hiring for Utilization Management Assistant jobs? Cities in Virginia with the most Utilization Management Assistant job openings:
Utilization Management Assistant jobs near you
Infographic showing various Utilization Management Assistant job openings in Virginia as of July 2026, with employment types broken down into 100% Full Time. Highlights an 91% In-person, and 9% Hybrid job distribution, with an average salary of $47,981 per year, or $23.1 per hour.
Utilization Review Specialist (Flexi)

Utilization Review Specialist (Flexi)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Posted 19 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Summary
The Utilization Review Specialist supports the organization's utilization management program by conducting routine admission, concurrent, and retrospective reviews utilizing established screening criteria and organizational guidelines. This position collects, reviews, and documents clinical information to support medical necessity determinations and appropriate resource utilization. Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
  • Conduct routine utilization reviews using approved screening criteria, established workflows, and departmental guidelines.
  • Collect and organize clinical documentation necessary to support utilization review activities.
  • Review patient records to identify required information for admission, continued stay, and discharge planning processes.
  • Apply established criteria to routine cases and document findings in designated systems.
  • Monitor assigned cases for required documentation and timely review completion.
  • Communicate with providers, clinical staff, payers, and care team members to obtain necessary information.
  • Identify cases that do not clearly meet established criteria and escalate them to an RN Utilization Review.
  • Present complex, high-acuity, disputed, or clinically ambiguous cases to an RN Utilization Review Specialist for evaluation and determination.
  • Assist with obtaining payer authorizations and tracking authorization status as directed.
  • Maintain accurate utilization management records, reports, and audit documentation.
  • Support denial prevention efforts through timely documentation and communication.
  • Participate in quality improvement initiatives related to utilization management processes.
  • Maintain knowledge of applicable payer requirements, regulatory standards, and organizational policies.
  • Assist with data collection and reporting related to utilization management metrics.
  • Perform other utilization management support duties within the scope of licensure and training.

Supervisory Responsibilities
Reports to: RN Clinical Doc Manager
Supervises: n/a
Responsibilities: n/a
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
Minimum Required Education:
Graduate of an approved healthcare program leading to licensure as a healthcare professional i.e. Licensed Practical Nurse (LPN) or other clinically licensed healthcare professionals as approved by the organization.
Experience:
Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related clinical healthcare functions may be considered.
Certificates, Licenses, Registrations:
Current unrestricted license as a Licensed Practical Nurse required at minimum in the Commonwealth of Virginia or compact state. Candidates possessing a higher level of clinical licensure are also eligible for consideration.
Certification in utilization management or case management preferred.
Physical Demands & Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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