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Utilization Management Auditor Jobs in Virginia (NOW HIRING)

SC&H Group

Risk Senior Manager

Tysons Corner, VA · On-site

People Leadership & Practice Management (20%) * Manage, coach, and develop a team of managers ... Experience coordinating with external auditors and working in regulated industries (SaaS, fintech ...

Castro & Company

Audit Manager

Alexandria, VA · On-site +1

$111K - $145K/yr

Meet or exceed targeted billing hours (utilization), and monitor the budget to ensure that work is ... Three (3) years of management experience in Medicare cost report auditing, settlement, and ...

Castro & Company

Audit Manager

Alexandria, VA · On-site

$111K - $145K/yr

Meet or exceed targeted billing hours (utilization), and monitor the budget to ensure that work is ... Three (3) years of management experience in Medicare cost report auditing, settlement, and ...

Markon

Space Planner with Security Clearance

Herndon, VA · On-site

$110K - $125K/yr

Markon is seeking a qualified Space Planner / Space Auditor to support facility planning, occupancy management, and space utilization initiatives for a government customer. The selected candidate ...

Markon

Space Planner

Charlottesville, VA · On-site

$110K - $125K/yr

Description Markon is seeking a qualified Space Planner / Space Auditor to support facility planning, occupancy management, and space utilization initiatives for a government customer. The selected ...

Markon

Space Planner

Charlottesville, VA · On-site

$110K - $125K/yr

Description Markon is seeking a qualified Space Planner / Space Auditor to support facility planning, occupancy management, and space utilization initiatives for a government customer. The selected ...

Markon

Space Planner

Herndon, VA

$110K - $125K/yr

Description Markon is seeking a qualified Space Planner / Space Auditor to support facility planning, occupancy management, and space utilization initiatives for a government customer. The selected ...

Markon

Space Planner

Herndon, VA

$110K - $125K/yr

Markon is seeking a qualified Space Planner / Space Auditor to support facility planning, occupancy management, and space utilization initiatives for a government customer. The selected candidate ...

McFadyen Digital

VP of Accounting

Vienna, VA

Manage margins, utilization, and key operational KPIs. * Lead external relationships and review sales contracts and legal documents. Primary contact for external auditors, tax advisors, bankers, and ...

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Utilization Management Auditor information

What is the highest paying job in healthcare management?

In healthcare management, executive roles such as Chief Executive Officer (CEO), Chief Operating Officer (COO), and Chief Financial Officer (CFO) tend to be the highest paying positions, often earning six-figure salaries. These roles require extensive experience, leadership skills, and often advanced degrees or certifications, and they oversee large healthcare organizations or systems.

Is a night auditor an entry level position?

A night auditor is typically an entry-level position in the hospitality industry, often suitable for individuals with basic customer service skills and some accounting knowledge. The role involves overnight shifts, reconciling accounts, and handling guest inquiries, and some employers may require prior experience or certifications in hospitality or accounting. However, the specific requirements can vary by employer and location.

What is the difference between Utilization Management Auditor vs Utilization Review Nurse?

AspectUtilization Management AuditorUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or CUCLicensed Registered Nurse (RN), often with additional certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinics, insurance companies, often in clinical settings
Primary FocusAuditing and reviewing utilization data for compliance and cost managementAssessing patient care needs and determining appropriate services

While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.

What are some common challenges faced by Utilization Management Auditors and how can they be addressed?

Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.

What is a Utilization Management Auditor?

A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.

Will AI take utilization management jobs?

Utilization Management Auditors perform reviews of healthcare services to ensure appropriate and efficient care. While AI tools can assist with data analysis and streamline certain tasks, the role requires critical thinking, clinical judgment, and regulatory knowledge that are not fully replaceable by AI at this time.

Is an auditor a high paying job?

Utilization Management Auditors typically earn salaries that are competitive within the healthcare and insurance industries, with pay varying based on experience, location, and certifications. While some auditing roles offer high salaries, they generally do not reach the highest pay levels compared to specialized or executive positions, but they can provide stable and rewarding careers for those with relevant skills and certifications. Factors such as industry demand and professional credentials influence earning potential.

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

To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
What are popular job titles related to Utilization Management Auditor jobs in Virginia? For Utilization Management Auditor jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Management Auditor jobs in Virginia look for? The top searched job categories for Utilization Management Auditor jobs in Virginia are:
What cities in Virginia are hiring for Utilization Management Auditor jobs? Cities in Virginia with the most Utilization Management Auditor job openings:
Utilization Management Auditor jobs near you
Infographic showing various Utilization Management Auditor job openings in Virginia as of July 2026, with employment types broken down into 91% Full Time, 3% Part Time, and 6% Contract. Highlights an 88% In-person, 6% Hybrid, and 6% Remote job distribution.
Revenue Integrity Nurse Auditor

Revenue Integrity Nurse Auditor

Childrens Hospital of The Kings Daughters

Chesapeake, VA

$35.34/hr

Full-time

Posted 10 days ago

Children's Hospital Of The King's Daughters rating

7.4

Company rating: 7.4 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

333rd of 1,020 rated hospitals

Job description

  • GENERAL SUMMARY
    • The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete reimbursement to the health system from third party payers. Reports to the department leadership 
  • ESSENTIAL DUTIES AND RESPONSIBILITIES
    • Ensures adherence to regulatory requirements related to billing and supporting documentation, as well as facilitates the completion of appeals in a timely manner.
    • Prepares trend and other reports for compliance audits and charge processes. 
    • Serves as a resource to hospital departments regarding compliance with billing regulations and trends in denials of services due to medical necessity or appropriateness of services. 
    • Conducts compliance, defense, LifeNet and special focus audits and reports findings. 
    • Serves as a clinical resource for coding / denial management and customer service issues. 
    • Participates as a member of the chargemaster team, providing clinical support and expertise on compliance related charge functioning. 
    • Identifies and works collaboratively to correct discrepancies in patient charges.
    • Performs other duties as assigned.
  • LICENSES AND/OR CERTIFICATIONS
    • Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact State license. 
    • Certified Professional Coder required. 
    • Certified Outpatient Coder (COC; formerly CPC-H) required within 1 year of hire. 
  • MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS
    • Graduate of a Bachelors of Science in Nursing program required. 
    • Minimum of 3 years of clinical experience as a Certified Professional Coder required.
    • Three to five years of case management utilization review, or compliance related work experience in a hospital setting preferred.
    • Pediatric experience preferred.
    • Current knowledge of third party billing, appeals, regulatory and accrediting requirements required. 
    • Exceptional analytical skills necessary to determine appropriateness of patient charges in relation to medical records and third party reimbursement.  
    • Interpersonal skills necessary in order to communicate effectively with other professionals. 
    • Demonstrates proficiency in MS Office and other health record management systems.
    • Knowledge of quality management methodologies, medical record documentation, compliance requirements and performance improvement system.   
    • Demonstrates the ability to prepare reports and summaries.
  • WORKING CONDITIONS
    • Normal office environment with little exposure to excessive noise, dust, temperature and the like.
  • PHYSICAL REQUIREMENTS
    • Click here to view physical requirements.

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