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Utilization Manager Jobs in Virginia (NOW HIRING)

Humana

Compliance UM Nurse (Wed - Sun)

Richmond, VA · 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 ...

Inova

Registered Nurse Case Manager

Falls Church, 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 ...

Evolent

Cardiology Physician

Arlington, VA

$407K - $460K/yr

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...

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 ...

Inova

Registered Nurse (RN) Case Manager 2

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 ...

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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 Aug 10, 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 are the key skills and qualifications needed to thrive as a utilization manager?

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 August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $90,231 per year, or $43.4 per hour.

Behavior Health Utilization Management Care Coordinator

Sentara Health

Woodbridge, VA • On-site

$10K/mo

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 398 frontline employees who took The Breakroom Quiz

491st of 887 rated healthcare providers

Job description

City/State

Woodbridge, VA

Work Shift

First (Days)

Overview:

Sentara Health is looking to hire a Behavior Health Utilization Management Care Coordinator

Standard working hours: 8am to 5pm EST, MF

This position will work with members under Sentara Health Plans who are both medically and behaviorally complex.

This position requires both in-person/face-to-face assessments and remote telephonic assessments for members with Serious Mental Illnesses, Serious Emotional Disturbances (ages 2+) and Substance Abuse Disorders!

Location: Applicants must be in Winchester, Stephens City, Leesburg, Fairfax, Chantilly, Front Royal, and Alexandria, VA.  Travel may include up to 90 minutes one way.  

Education:

  • Bachelor’s degree (required)

Certification/Licensure:

Required license must be valid in state of practice. One of the following:

  • Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Clinical Social Worker (LCSW) - State license - North Carolina Social Work Certification and Licensure Board (NCSWCLB) OR 
  • Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Professional Counselor (LPC) - State license - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) OR 
  • Licensed Marriage and Family Therapist (LMFT) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Marriage and Family Therapist (LMFT) - State license - North Carolina Marriage and Family Therapy Licensure Board (NCBMFT) OR 
  • Licensed Substance Abuse Treatment Practitioner (LSTAP) - State license - Virginia Department of Health Professionals (VADHP)  
  • Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON) 

Experience 

  • 2 years of behavioral health (Required) 
  • 1 year of case management (Required) 

Keywords: Talroo- Health, LCSW, LPC, NCBLCMHC, LMFT, NCBMFT, LSTAP, RN, Care Coordinator, Behavioral Health

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• Reimbursement for certifications and free access to complete CEUs and professional development•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 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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