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Utilization Manager Jobs in Virginia (NOW HIRING)

Sedgwick

RN Utilization Review

Richmond, VA

$73K - $75K/yr

To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive ...

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RN Case Manager

Falls Church, VA · On-site

$44.14/hr

Support quality and utilization management processes * May mentor new team members once proficient in role Required Qualifications * Active, unrestricted RN license in the State of Virginia * BSN ...

Inova

Registered Nurse (RN) Case Manager

Fairfax, VA · On-site

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Ashburn, VA · On-site +1

$58.50 - $71.25/hr

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Virginia

Utilization Manager information

See Virginia salary details

$38.7K

$90.2K

$166.1K

How much do utilization manager jobs pay per year?

As of Jun 8, 2026, the average yearly pay for utilization manager in Virginia is $90,231.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,000.00 and $108,600.00 per year, depending on experience, location, and employer.

What does a Utilization Manager do?

A Utilization Manager is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their primary goal is to ensure that patients receive the right care at the right time while also controlling costs for hospitals, insurance companies, or healthcare organizations. Utilization Managers review patient records, coordinate with healthcare providers, and use clinical guidelines to make informed decisions about treatment approvals or denials. They play a key role in maintaining quality care and regulatory compliance.

What are the key skills and qualifications needed to thrive as a Utilization Manager, and why are they important?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by Utilization Managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What Is a Utilization Manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs
What are the most commonly searched types of Utilization jobs in Virginia? The most popular types of Utilization jobs in Virginia are:
What are popular job titles related to Utilization Manager jobs in Virginia? For Utilization Manager jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Manager jobs in Virginia look for? The top searched job categories for Utilization Manager jobs in Virginia are:
What cities in Virginia are hiring for Utilization Manager jobs? Cities in Virginia with the most Utilization Manager job openings:
What are popular job titles related to Utilization Manager jobs in VA? For Utilization Manager jobs in VA, the most frequently searched job titles are:
Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Virginia as of May 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $90,231 per year, or $43.4 per hour.
Utilization Review/Office Manager

Utilization Review/Office Manager

Hallmark Youthcare Richmond, Inc.

Richmond, VA • On-site

$26/hr

Full-time

Posted 7 days ago

Job description

We are seeking a detail-oriented and organized professional to support both utilization review operations and day-to-day office management. This role plays an important part in ensuring efficient administrative processes, coordinated patient care workflows, and a positive experience for staff, clients, and visitors. The ideal candidate is adaptable, highly organized, and comfortable balancing multiple responsibilities in a fast-paced environment.
Starting salary at $26 hourly, commensurate with experience
Responsibilities
  • Coordinate utilization review activities to support authorization, eligibility, and continued stay processes as applicable.
  • Review documentation for completeness, accuracy, and compliance with organizational and payer requirements.
  • Communicate with internal teams, external partners, and insurance representatives regarding case status and administrative needs.
  • Track deadlines, follow up on pending reviews, and maintain organized records.
  • Support office operations including scheduling, correspondence, supply management, and general administrative tasks.
  • Serve as a point of contact for staff and visitors, providing professional and responsive support.
  • Assist with training coordination and day-to-day office workflow improvements.
  • Prepare reports, maintain logs, and help ensure accurate documentation across assigned functions.
  • Support compliance with internal policies, procedures, and applicable regulations.
  • Perform additional duties as needed to support the needs of the team and organization.

Qualifications
  • Previous experience in utilization review, case management support, office management, or a similar administrative role preferred.
  • Strong organizational skills with the ability to manage multiple priorities and deadlines.
  • Excellent written and verbal communication skills.
  • Proficiency with common office software and electronic documentation systems.
  • Attention to detail and a commitment to accuracy in recordkeeping and communication.
  • Ability to handle sensitive information with professionalism and discretion.
  • Strong problem-solving skills and a customer service-oriented approach.
  • Ability to work independently as well as collaboratively with a team.

Preferred Attributes
  • Experience working in a healthcare, behavioral health, or human services environment.
  • Knowledge of utilization review processes, insurance coordination, or managed care practices.
  • Familiarity with scheduling systems, reporting tools, and administrative workflow management.

What We Offer
  • A collaborative and supportive work environment.
  • Opportunity to contribute to both operational excellence and service quality.
  • The chance to take ownership of meaningful administrative and review processes.
  • Competitive compensation and benefits, based on experience and qualifications.

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