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Utilization Review Case Manager Jobs in Virginia

Carilion Clinic

RN Case Manager

Roanoke, VA

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

RN Case Manager (Open) Full time : Monday - Friday, 8am-4:30pm Sign on bonus and relocation ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

R152941 RN Case Manager - Weekends (Open) How You'll Help Transform Healthcare: The RN Case Manager ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

R161366 RN Case Manager - Weekdays (Open) How You'll Help Transform Healthcare: Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

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Utilization Review Case Manager information

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$36

$59

How much do utilization review case manager jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review case manager in Virginia is $36.17, according to ZipRecruiter salary data. Most workers in this role earn between $29.33 and $38.12 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Review Case Manager jobs in Virginia?

For Utilization Review Case Manager jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Review Case Manager jobs in Virginia look for?

The top searched job categories for Utilization Review Case Manager jobs in Virginia are:

What cities in Virginia are hiring for Utilization Review Case Manager jobs?

Cities in Virginia with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Virginia as of August 2026, with employment types broken down into 56% Full Time, and 44% Contract. Highlights an 100% In-person job distribution, with an average salary of $75,240 per year, or $36.2 per hour.

Utilization Review Specialist (Flexi)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Re-posted 11 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Summary
The Utilization Review Specialist supports the organization's utilization management program by conducting routine admission, concurrent, and retrospective reviews utilizing established screening criteria and organizational guidelines. This position collects, reviews, and documents clinical information to support medical necessity determinations and appropriate resource utilization. Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
  • Conduct routine utilization reviews using approved screening criteria, established workflows, and departmental guidelines.
  • Collect and organize clinical documentation necessary to support utilization review activities.
  • Review patient records to identify required information for admission, continued stay, and discharge planning processes.
  • Apply established criteria to routine cases and document findings in designated systems.
  • Monitor assigned cases for required documentation and timely review completion.
  • Communicate with providers, clinical staff, payers, and care team members to obtain necessary information.
  • Identify cases that do not clearly meet established criteria and escalate them to an RN Utilization Review.
  • Present complex, high-acuity, disputed, or clinically ambiguous cases to an RN Utilization Review Specialist for evaluation and determination.
  • Assist with obtaining payer authorizations and tracking authorization status as directed.
  • Maintain accurate utilization management records, reports, and audit documentation.
  • Support denial prevention efforts through timely documentation and communication.
  • Participate in quality improvement initiatives related to utilization management processes.
  • Maintain knowledge of applicable payer requirements, regulatory standards, and organizational policies.
  • Assist with data collection and reporting related to utilization management metrics.
  • Perform other utilization management support duties within the scope of licensure and training.

Supervisory Responsibilities
Reports to: RN Clinical Doc Manager
Supervises: n/a
Responsibilities: n/a
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
Minimum Required Education:
Graduate of an approved healthcare program leading to licensure as a healthcare professional i.e. Licensed Practical Nurse (LPN) or other clinically licensed healthcare professionals as approved by the organization.
Experience:
Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related clinical healthcare functions may be considered.
Certificates, Licenses, Registrations:
Current unrestricted license as a Licensed Practical Nurse required at minimum in the Commonwealth of Virginia or compact state. Candidates possessing a higher level of clinical licensure are also eligible for consideration.
Certification in utilization management or case management preferred.
Physical Demands & Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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