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Utilization Review Manager Jobs in Virginia (NOW HIRING)

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...

Summit BHC

Utilization Assistant- Acute

Williamsburg, VA · On-site

$20 - $24/hr

The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of ...

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

Utilization Review Manager information

See Virginia salary details

$38.7K

$90.2K

$166.1K

How much do utilization review manager jobs pay per year?

As of Jul 14, 2026, the average yearly pay for utilization review 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 some common challenges faced by Utilization Review Managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

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

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a Utilization Review Manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
What are the most commonly searched types of Utilization Review jobs in Virginia? The most popular types of Utilization Review jobs in Virginia are:
What are popular job titles related to Utilization Review Manager jobs in Virginia? For Utilization Review Manager jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Virginia look for? The top searched job categories for Utilization Review Manager jobs in Virginia are:
What cities in Virginia are hiring for Utilization Review Manager jobs? Cities in Virginia with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Virginia as of July 2026, with employment types broken down into 85% Full Time, 13% Part Time, 1% Temporary, and 1% Contract. Highlights an 86% Physical, 1% Hybrid, and 13% Remote job distribution, with an average salary of $90,231 per year, or $43.4 per hour.
Utilization Review Specialist (Flexi)

Utilization Review Specialist (Flexi)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Posted 8 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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