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Utilization Management Case Manager Rn Jobs in Virginia

CVS Health

Case Manager, Registered Nurse

Richmond, VA · On-site

$54K - $155K/yr

Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization ... A RN who resides in a compact state is required to have an active multistate license through the ...

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Sentara

Inpatient Case Manager-RN

Suffolk, VA · On-site

$10K/mo

... management. Promotes effective utilization and monitoring of health services, collaborates and ... Case Management, Inpatient, Critical Care, De-escalation, Integrated Care Management, RN, ...

Sentara Health

Inpatient Case Manager-RN

Suffolk, VA

$89K - $136K/yr

... Case Manager, Inpatient Case Manager, Registered Nurse Hours: 8:00 - 4:30 PM Telephonic ... management. Promotes effective utilization and monitoring of health services, collaborates and ...

Sentara Health

Inpatient Case Manager-RN

Suffolk, VA · On-site

$89K - $136K/yr

... Case Manager, Inpatient Case Manager, Registered Nurse Hours: 8:00 - 4:30 PM Telephonic ... management. Promotes effective utilization and monitoring of health services, collaborates and ...

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All JobsUtilization Management Case Rn JobsUtilization Management Case Manager Rn JobsUtilization Management Case Manager Rn Jobs in Virginia

Utilization Management Case Manager Rn information

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

AspectUtilization Management Case Manager RnUtilization Review Nurse
CredentialsRN license, certification in case management (e.g., CCM)RN license, often with certification in utilization review
Work EnvironmentInsurance companies, healthcare facilities, case management teamsHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing cases, ensuring appropriate utilizationReviewing medical necessity, approving or denying services
Common TasksAssessing patient needs, developing care plans, liaising with providersEvaluating medical records, making utilization decisions, ensuring compliance

The main difference is that the Utilization Management Case Manager Rn focuses on coordinating patient care and managing cases, while the Utilization Review Nurse primarily reviews medical records to approve or deny services. Both roles require RN licensure and related certifications, but their daily responsibilities and work environments differ slightly.

Are utilization management case managers in demand?

Utilization management case managers are in demand due to the growing need for healthcare cost control and efficient patient care coordination. Employers in healthcare organizations, insurance companies, and managed care plans seek professionals with strong clinical knowledge, certification, and experience in utilization review processes. The role offers stable employment opportunities as healthcare systems focus on cost-effective treatment management.

What cities in Virginia are hiring for Utilization Management Case Manager Rn jobs?

Cities in Virginia with the most Utilization Management Case Manager Rn job openings:

Infographic showing various Utilization Management Case Manager Rn job openings in Virginia as of June 2026, with employment types broken down into 79% Full Time, 16% Part Time, and 5% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Inpatient Case Management- Registered Nurse - Emergency Department

Hampton, VA • On-site

Sentara Healthcare
Hospitals • 10K+ employees
Learn more about Sentara Healthcareexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

Job description

City/State
Hampton, VA
Work Shift
First (Days)
Overview:
Generous sign-on bonus 20K for qualified candidates and positions.
Sentara Careplex Hospital is hiring an Inpatient Case Manager, RN.
Inpatient Case Manager, Registered Nurse
Shift: Days/8 Hours
Overview
The ICM, RN position will support the Emergency Department which will have responsibility to the health plans members. This position functions as part of our integrated delivery system care coordination model. While operationally aligned to hospital leadership, the role maintains shared accountability to health plan clinical leadership to support high-risk member management, utilization reduction strategies, care transition performance, and enterprise population health objectives.
Responsible and accountable for the provision and facilitation of comprehensive care management, services, and quality outcomes for patients across the healthcare continuum, primary focus on the patient transition to the appropriate level of care while facilitating clinical appropriateness and LOS. Directly support those in-hospital patients identified in need of comprehensive case management. Promotes effective utilization and monitoring of health services, collaborates and communicates with the healthcare team and patient/caregiver to manage care and transitions. Develops and/or implements a comprehensive care plan based on assessment and evaluation to include the physical, mental, and psychosocial needs of the inpatient/caregiver. Functions in one of the following practice settings: Hospitals Only.
Education
  • RN-Associate's Degree OR
  • RN-Bachelor's Degree OR
  • RN-Diploma OR
  • RN-Master's Degree OR
  • RN-Doctorate Degree

Certification/Licensure
  • Registered Nurse (RN) License - Compact/Multi-State License OR
  • Registered Nurse (RN) License - Single State - Virginia
  • Basic Life Support (BLS) - Certification - American Heart
  • Case Management (ACM, CCM, CCCTM, CMAC, or CMGT-BC) certification is required within one year of eligibility.
  • Association (AHA) BLS within 90 days of hire.

Experience
  • 1 year of nursing experience (required)
  • 1 year acute care experience (preferred)
  • 1 year case management experience (preferred)
  • Emergency Department (ED) and or/Case Management (preferred)

Keywords: Case Management, Inpatient, Critical Care, De-escalation, Integrated Care Management, RN, Registered Nurse, ACM, CCM, CCCTM, RN-B, Community Resources, Talroo-Nursing, Discharge Planning, Home Rehabilitation, Flexi, Emergency Department
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
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara CarePlex Hospital, located in Hampton, VA, is a 224-bed technologically advanced, acute care facility, and Certified Primary Stroke Center. Other features include specialized services in heart and vascular, urologic care, along with advanced diagnostic and surgical capabilities, a hospitalist program, and one of the state's busiest emergency departments. We are also home to the Orthopedic Hospital at Sentara CarePlex Hospital, the area's first dedicated orthopedic hospital. We improve health every day, come be a part of the community.
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:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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