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Utilization Management Coordinator Jobs in Virginia

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

$60 - $80/hr

Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision ...

Lthc

Clinical Pharmacist, Utilization Management

Jamestown, VA · On-site

$108K - $129K/yr

Collaborates with Decision Criteria Coordinator to maintain and update decision criteria and denial ... Managed care experience is strongly preferred, especially experience in utilization management. In ...

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

Microsoft suite (Word, Excel, Outlook) (preferred) Keywords Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA Benefits Caring For ...

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Utilization Management Coordinator information

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$15

$29

$46

How much do utilization management coordinator jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for utilization management coordinator in Virginia is $29.35, according to ZipRecruiter salary data. Most workers in this role earn between $21.20 and $34.33 per hour, depending on experience, location, and employer.

What does a utilization management coordinator do?

A Utilization Management Coordinator is responsible for reviewing and assessing healthcare services to ensure that patients receive appropriate care while managing costs for healthcare providers or insurance companies. They evaluate medical records, coordinate with healthcare professionals, and help determine if certain treatments or procedures are medically necessary according to established guidelines. Their goal is to optimize the use of healthcare resources, prevent unnecessary treatments, and support quality patient outcomes.

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

To thrive as a Utilization Management Coordinator, you need a background in healthcare or nursing, knowledge of medical terminology, and experience in case management or utilization review, often supported by a relevant degree or certification (such as RN or LPN). Familiarity with utilization management software, electronic health records (EHRs), and insurance authorization platforms is typically required. Strong organizational skills, attention to detail, and effective communication are essential soft skills for this role. These capabilities ensure accurate review of medical cases, compliance with regulations, and efficient coordination between providers, payers, and patients.

How does a utilization management coordinator typically collaborate with clinical staff and insurance providers?

A Utilization Management Coordinator serves as a vital link between healthcare providers, clinical staff, and insurance companies. They regularly communicate with physicians and nurses to gather clinical information, review treatment plans, and ensure that proposed services meet medical necessity criteria. Coordinators also interact with insurance providers to obtain pre-authorizations, clarify coverage policies, and appeal denied claims when appropriate. Effective collaboration and strong communication skills are essential, as the role requires balancing the needs of patients, providers, and payers while ensuring timely and cost-effective care.

What degree do you need for utilization management coordinator?

A utilization management coordinator typically needs at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.

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 are popular job titles related to Utilization Management Coordinator jobs in Virginia?

For Utilization Management Coordinator jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Management Coordinator jobs in Virginia look for?

The top searched job categories for Utilization Management Coordinator jobs in Virginia are:

What cities in Virginia are hiring for Utilization Management Coordinator jobs?

Cities in Virginia with the most Utilization Management Coordinator job openings:

Utilization Management Coordinator jobs near you
Infographic showing various Utilization Management Coordinator job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 20% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $61,057 per year, or $29.4 per hour.

Senior Consultant - Clinical Utilization Management SME

Tria Federal

Arlington, VA • On-site

Other

Medical, Life

This job post has expired today. Applications are no longer accepted.

Job description

Who we are:

Tria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members and civilians. For two decades, federal agencies have relied on Tria companies to advance their critical missions and modernize their systems, so that they can uphold their commitment to the American people. Today, we are pushing the boundaries of possibility through partnerships and investments in artificial intelligence and emerging technologies, developing solutions for the biggest challenges that government will face tomorrow.

We are proud to employ and support military veterans who bring mission-first mindset, technical expertise, and leadership qualities that strengthen our work. Veterans, transitioning service members, and military spouses are strongly encouraged to apply.

Tria Federal is seeking a Senior Consultant - Clinical Utilization Management SME to provide clinical and utilization-management expertise supporting the Department of Veterans Affairs. The SME will apply utilization-management expertise to assess clinical processes, medical-necessity workflows, referral and authorization processes, care coordination, utilization patterns, and clinical risk.

The ideal candidate is a licensed RN (or other clinical degree / license) with significant experience in utilization management, care management, prior authorization, clinical review, medical necessity, appeals, care coordination, or payer/provider clinical operations.

Responsibilities:
  • Provide clinical subject matter expertise in utilization management, care management, medical necessity, and clinical review.
  • Assess referral, authorization, utilization-management, and care-coordination workflows and identify barriers to timely care.
  • Review clinical and operational processes for opportunities to improve access, quality, appropriateness, cost, and patient outcomes.
  • Evaluate utilization trends and identify clinical, operational, and process drivers of variation.
  • Support development and refinement of clinical workflows, protocols, decision support, and standard operating procedures.
  • Conduct clinical root-cause analysis involving access, utilization, care coordination, denials, medical documentation, and patient-care impacts.
  • Support evaluation of utilization-management practices across providers.
  • Develop clinical recommendations and executive-level analyses that clearly articulate patient-care, operational, financial, and compliance impacts.
  • Collaborate with physicians, nurses, healthcare administrators, network teams, payment SMEs, and VA stakeholders.
  • Support clinical requirements development, operational readiness, implementation, training, and change-management activities.
  • Contribute to assessments, white papers, decision papers, risk analyses, and performance frameworks.
Skills & Experience:
  • 7+ years of healthcare clinical operations, utilization management, care management, case management, clinical review, or related experience.
  • 3+ years of direct utilization-management or clinical review experience preferred.
  • Experience with medical necessity review, prior authorization, concurrent review, retrospective review, appeals, or care management.
  • Understanding of healthcare payer/provider workflows and clinical documentation.
  • Ability to translate clinical findings into operational and executive recommendations.
  • Strong written and verbal communication skills.
  • Bachelor's degree required; BSN preferred.
Qualifications:
  • Active, unrestricted Registered Nurse (RN) license.
  • Medicare Advantage, Medicaid, commercial payer or government payer experience.
  • InterQual, MCG/Care Guidelines, or comparable clinical decision-support experience.
  • Utilization-management accreditation or quality experience.
  • Population health/care management.
  • Behavioral health, post-acute care, specialty care, emergency care, or high-cost/high-risk population experience.
  • VA/VHA experience.
  • CCM, ACM, CPHQ, or similar certification.

Why Tria?
What defines the Tria brand is more than just our dedication to excellence in our craft; it's our incredible team of dedicated, talented, and passionate people that make Tria so exceptional. As people powering possible, we are all partners in our team's shared success.


As a company that cares about people, we seek to cultivate a culture in which all can thrive personallyandprofessionally. We offer a top-tier benefits package to invest in your physical, mental, and financial health and wellness so that you can be your best self - at workand in life. At Tria, we are growth-minded, entrepreneurial in spirit, and committed to fostering a culture of inclusion and opportunity for all. Whatever your background, your role, your department, or stage in your professional journey, here you will have opportunities to learn new skills, seize new challenges, and advance your career as we grow.

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We are committed to protecting your privacy. As part of our compliance with the California Consumer Privacy Act (CCPA), we want to inform you about how we collect, use, and protect your personal information during the job application process. For more details, please review https://www.oag.ca.gov/privacy/ccpa.

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