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Utilization Management Jobs in West Virginia (NOW HIRING)

Sound Physicians

Internal Medicine Physician

Beckley, WV · On-site

$325K/yr

The team leads utilization management (UM) efforts, clinical documentation improvement (CDI), education, and regulatory compliance. Our role is to drive performance improvements in length of stay ...

Pharmacy Careers

Remote Clinical Review Pharmacist

Huntington, WV · On-site

$115K - $137K/yr

Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document recommendations and decisions according to health-plan and regulatory requirements. * Participate in ...

Posted today

Humana

Compliance UM Nurse (Wed - Sun)

Charleston, WV · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

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Showing results 1-20

All JobsUtilization Management JobsUtilization Management Jobs in West Virginia

Utilization Management information

See West Virginia salary details

$30.2K

$69.3K

$126.2K

How much do utilization management jobs pay per year?

As of Aug 9, 2026, the average yearly pay for utilization management in West Virginia is $69,275.00, according to ZipRecruiter salary data. Most workers in this role earn between $49,900.00 and $80,900.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the most commonly searched types of Utilization Management jobs in West Virginia? The most popular types of Utilization Management jobs in West Virginia are:
What are popular job titles related to Utilization Management jobs in West Virginia? For Utilization Management jobs in West Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in West Virginia look for? The top searched job categories for Utilization Management jobs in West Virginia are:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in West Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 62% In-person, and 38% Remote job distribution, with an average salary of $69,275 per year, or $33.3 per hour.

Medical Director of Advisory Services

Sound Physicians

Huntington, WV

$325K/yr

Full-time

Medical, Retirement, PTO

Posted 27 days ago

Job description

Join our Medical Group as an Executive Leader and Medical Director, Advisory Services, providing on-site advisory services to partner hospitals. This role focuses on leading utilization management (UM), compliance, and clinical documentation improvement (CDI) efforts. You will collaborate with hospital administration to identify and address performance improvement opportunities, including length of stay, readmissions, improved documentation, and regulatory compliance.

Practice Info

  • Physician advisors operate across multiple states, including Arizona, California, Florida, Kentucky, Nevada, and West Virginia, collaborating with partner hospitals to improve services and outcomes.
  • The team leads utilization management (UM) efforts, clinical documentation improvement (CDI), education, and regulatory compliance.
  • The role is to drive performance improvements in length of stay, readmissions, and documentation.

Responsibilities

  • Provide leadership and oversight of advisory services.
  • Serve as a visible physician leader and advocate for improved regulatory compliance, improved documentation, and improved utilization of hospital resources.
  • Provide support to address and reduce payer denials.
  • Develop action plans on performance improvement opportunities.
  • Provide one-on-one as well as group education to the medical staff.
  • Provide timely and effective consultation to case management, CDI specialists, physicians, and other staff at the hospital with documented determinations and observations.

Compensation

  • Total yearly compensation is up to $325,000, commensurate with experience

Benefits

  • Health benefits
  • CME allowance
  • PTO
  • 401k

Shift & Schedule

  • Monday - Friday, providing a healthy work-life balance.

Requirements

  • MD or DO licensure within the state of employment.
  • Experience in Utilization Management, compliance, and clinical documentation preferred.
  • Strong leadership, education, and collaboration skills.
  • Board Certification (base specialty) recognized by ABMS or ABQAURP.
  • Education on the application of medical necessity criteria within three months of hire.
  • Three years of post-residency experience as a physician advisor preferred.
  • Authorized to work in the United States.
  • No visa sponsorship available.
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About Sound Physicians

Sourced by ZipRecruiter

Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care. For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology and analytics to consistently improve clinical and financial performance. We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Tacoma, WA, US

Year founded

2001

Social media

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