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Utilization Management Auditor Jobs in Virginia (NOW HIRING)

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 ...

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 ...

Financial Specialist II

Fairfax, VA · On-site

$70K - $122K/yr

... and compilation, auditing, oversight and review of third-party property management company ... Ability to plan and implement activities in order to ensure effective and efficient utilization of ...

Senior Accountant

Petersburg, VA

$72K - $91K/yr

Senior Accountant This position is responsible for managing the full cycle of accounting, ensuring ... Prepare audit schedules and provide documentation for internal and external auditors * Monitor and ...

Showing results 21-40

Utilization Management Auditor information

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.

What are the key skills and qualifications needed to thrive as a utilization management auditor?

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 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 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 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:

Infographic showing various Utilization Management Auditor 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 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Risk Senior Manager

SC&H Group

Tysons Corner, VA • On-site

Full-time

Medical, Retirement, PTO

Re-posted 15 days ago


Job description

SC&H's Risk Practice is seeking a Senior Manager to lead and grow our service line with a strong focus on security-related consulting, including SOC (SSAE 18), ISO/IEC 27001, and ISO/IEC 42001 engagements. The ideal candidate combines sales/business development acumen, team leadership, and deep delivery expertise to shape client outcomes, scale practices, and develop high-performing teams. This role includes measurable growth responsibilities, client oversight, and engagement leadership across highly regulated and high-growth industries.

Work You'll Do:

  • Business Development & Growth (40%)
    • Own a personal book-of-business growth target; lead opportunity pursuit from prospecting through close (RFPs, proposals, orals, scoping, pricing).
    • Build and manage an opportunity pipeline across SOC (1/2/3), readiness, ISO 27001 ISMS implementation/assessments, ISO 42001 (AI Management System) readiness/certification guidance, and security program advisory.
    • Develop go-to-market (GTM) offerings, thought leadership, and partner/alliances; collaborate with Marketing on campaigns and events.
    • Expand client relationships at the CISO, CIO, CTO, CAE, CFO levels; lead cross-sell with Assurance, Tax, and other Cyber/Technology teams.
  • Engagement Leadership & Delivery (40%)
    • Lead SOC (SSAE 18) readiness and examination projects (SOC 1 Type 1/2, SOC 2 Type 1/2, SOC 3), including scoping, testing strategy, and report quality.
    • Lead ISO/IEC 27001 implementations (ISMS design, risk assessment, controls, internal audits, certification readiness) and ISO/IEC 42001 readiness/implementation for AI governance.
    • Oversee delivery quality, risk, and timelines across multiple concurrent engagements; ensure methodology compliance and audit defensibility.
  • People Leadership & Practice Management (20%)
    • Manage, coach, and develop a team of managers/ seniors/ associates; lead staffing, utilization, and performance.
    • Champion a collaborative, inclusive, and learning-oriented culture; provide timely feedback and career guidance.
    • Strengthen delivery playbooks, templates, and accelerators; contribute to practice P&L hygiene (pricing discipline, margin, WIP/AR, scope management).

Qualifications

  • Required
    • 8–12+ years of progressively responsible experience in public accounting, consulting, or a comparable risk/security practice.
    • Proven track record in SOC (SSAE 18) readiness and examinations (SOC 1/SOC 2), including planning, testing, supervision, and reporting.
    • Hands-on experience with ISO/IEC 27001 (ISMS design/implementation, internal audit, certification readiness) and familiarity with ISO/IEC 42001 (AI Management System) frameworks and AI governance concepts.
    • Demonstrated sales/business development success (pipeline creation, proposals/orals, solutioning, closing) and account growth.
    • People leadership experience: managing teams, setting priorities, and developing talent across multiple engagements.
    • Strong understanding of security and IT risk domains (identity and access, change/configuration, secure engineering, vendor risk, cloud controls, incident response, logging/monitoring, data governance, AI governance).
    • Excellent client communication, executive presence, and stakeholder management skills.
    • Prior practice-building responsibilities (offerings, pricing models, partner alliances).
  • Preferred
    • Experience coordinating with external auditors and working in regulated industries (SaaS, fintech, healthcare, critical infrastructure).
    • Working knowledge of cloud security (Azure, AWS, GCP) and enabling platforms (e.g., M365/Entra ID, ServiceNow GRC, Archer, OneTrust).
  • Education & Certifications
    • Bachelor’s degree in Accounting, Information Systems, Computer Science, Cybersecurity, or related field; Master’s degree a plus.
    • One or more of the following required:
      • CISA (Certified Information Systems Auditor)
      • ISO/IEC 27001 Lead Implementer or Lead Auditor (or equivalent ISO credential)
      • CPA (active)
    • Additional relevant certifications a plus: CISSP, CCSP, CRISC, CISM, ISO/IEC 42001-related training/credentials.
  • Key Performance Indicators (KPIs)
    • Bookings & Revenue: Meets/exceeds individual and practice sales targets; healthy pipeline coverage, appropriate recovery/margins
    • Client Satisfaction & Expansion: New service-line cross-sells; referenceable clients.
    • People Metrics: Team utilization, retention, timely feedback, and progression of staff.

Any unsolicited resumes submitted through our website or to SC&H Group, Inc., employee e-mail accounts are considered property of SC&H Group, Inc., and are not subject to payment of agency fees. In order to be an authorized recruitment agency ("search firm") for SC&H Group, Inc., there must be a formal written agreement in place and the agency must be invited, by SC&H's Talent Acquisition team, to submit candidates for review.

ABOUT SC&H

SC&H is an employee-owned, global consulting and financial services firm – home to people who believe in the power of trusted personal relationships. Everyone here shares a passion for driving results, fueled by the genuine connections we forge. Our expert capabilities and exceptional service have shaped the firm’s longstanding reputation for excellence and impressive growth. But it’s the partnerships we build and the success we help deliver that make each day rewarding — for our colleagues, our clients, and our communities.

Recognized annually by Inc., Baltimore Business Journal, Accounting Today, and Inside Public Accounting as a “Best Place to Work,” SC&H is routinely named one of the fastest-growing firms for organic growth in the United States. Our success is powered by 13 diverse practices at the intersection of finance, technology, and accounting; 430+ professionals across offices in Maryland, Tysons Corner / Washington D.C., Philadelphia, Chicago, and India; and a client base ranging from emerging growth to world-renowned Fortune 500 companies. This is the place to build lasting professional relationships, grow your skills, and fulfill your potential. 

SC&H
Make it Rewarding.

Salary & Benefits

The expected annual base salary for this position is $140,000-$175,000. Salary offers are made based on a variety of candidate specific factors such as candidate's skills, performance, job responsibilities, prior relevant experience, certain degrees and certifications and market considerations. As a 100% employee-owned firm, SC&H offers the unique benefit of real equity ownership for every colleague with at least 1 year of service. Watch your stake grow as your tenure increases and the firm achieves success. We also offer a comprehensive health plan with multiple options to suit your needs, at least 4 weeks of paid time off, 8 firm-paid holidays, 401k with employer match, and an annual firm trip for you and a guest to an all-inclusive tropical location.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.