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Utilization Review Case Manager Jobs in Virginia

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

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

R161382 RN Case Manager - Weekends (Open) How You'll Help Transform Healthcare: Full time and ... 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 ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

R161382 RN Case Manager - Weekends (Open) How You'll Help Transform Healthcare: Full time and ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Lifepoint Health

RN Case Manager

Danville, VA · On-site

Our collaborative approach to safe, effective discharge planning includes close coordination between a Utilization Review RN, Case Manager RN, and Social Worker-ensuring each patient receives ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Virginia

Utilization Review Case Manager information

See Virginia salary details

$16

$36

$59

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

As of Jul 26, 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 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 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 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 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 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 July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $75,240 per year, or $36.2 per hour.
Utilization Review/Office Manager

Utilization Review/Office Manager

HALLMARK YOUTHCARE RICHMOND INC

Richmond, VA

$26 - $28/hr

Full-time

Posted 23 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.