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Utilization Management Nurse Jobs in Virginia (NOW HIRING)

UHS

Director of Utilization Management

Danville, VA · On-site

Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...

UHS

Director of Utilization Management

Danville, VA · On-site

Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...

Inova

Registered Nurse (RN) Case Manager

Alexandria, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse (RN) Case Manager 1 Job Responsibilities: * Collects delay and other data for ...

Inova

Registered Nurse (RN) Case Manager

Falls Church, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse (RN) Case Manager 1 Job Responsibilities: * Collects delay and other data for ...

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All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Virginia

Utilization Management Nurse information

See Virginia salary details

$38.7K

$88.7K

$161.6K

How much do utilization management nurse jobs pay per year?

As of Sep 4, 2026, the average yearly pay for utilization management nurse in Virginia is $88,715.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,900.00 and $103,600.00 per year, depending on experience, location, and employer.

What is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

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

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

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

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

More about Utilization Management Nurse jobs

What are the most commonly searched types of Utilization Management Nurse jobs in Virginia?

The most popular types of Utilization Management Nurse jobs in Virginia are:

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

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

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

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

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

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

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Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $88,715 per year, or $42.7 per hour.

Clinical Nurse - Utilization Manager

Saratoga Medical Center

Falls Church, VA • On-site

Full-time

Medical, PTO

Re-posted 25 days ago

Job description

Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options.

This is a great full-time opportunity with telework available. Please see the qualifications below and submit your resume if you are interested in being considered. 


Required Qualifications:

  • Bachelor's degree in Nursing, Master's preferred, or other clinically related Health Service degree. 
  • Department of Defense Program Management (PM) experience preferred, minimum 2 years within the last 5 years. 
  • Experience in the operations and organization of the Department of Defense Military Health System desired. 





Saratoga Medical Center, Inc. is an equal opportunity employer and will not discriminate in recruiting, hiring, training, promotion, transfer, discharge, compensation or any other term or condition of employment on the basis of race, religion, color, age (over age 39), sex, national origin, or on the basis of disability if the employee can perform the essential functions of the job, with a reasonable accommodation if necessary.