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Utilization Review Manager Jobs in Virginia (NOW HIRING)

Humana

Utilization Management RN

Richmond, VA · On-site

This role will report directly to the Manager, Utilization Management. Key Responsibilities: Clinical Review: · Conduct comprehensive clinical reviews of prior authorization requests to determine ...

Pharmacy Careers

Remote Clinical Review Pharmacist

Arlington, VA · On-site

$136K - $163K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

Posted today

UHS

UTILIZATION COORDINATOR

Danville, VA · On-site

... and payor and managing timely transitions through the phases of residential care. Key ... review and respond to concerns expressed by customers. Together with the appropriate Department ...

UHS

Director of Utilization Management

Danville, VA · On-site

$79K - $95K/yr

Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ... or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...

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 ...

GQR

RN - Case Manager

Charlottesville, VA · On-site

$1.8K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Charlottesville, Virginia Start Date: August 17, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

UHS

UR COORDINATOR

Danville, VA · On-site

$26 - $35/hr

Our team also works diligently to address or manage medical conditions and challenging behaviors ... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ...

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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 Aug 9, 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.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

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?

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 August 2026, with employment types broken down into 82% Full Time, 16% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $90,231 per year, or $43.4 per hour.

Physician Advisor Utilization Review(MD/DO)

Inova

Fairfax, VA • Hybrid

Part-time

Medical, Dental, Vision, PTO

Re-posted 16 days ago

Inova Health System rating

7.5

Company rating: 7.5 out of 10

Based on 260 frontline employees who took The Breakroom Quiz

231st of 887 rated healthcare providers

Job description

Inova Fairfax Medical Campus is looking for a dedicated physician advisor to join the Utilization Review Advisor team. This role will be a part-time position.


The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Inova hospital facilities. The Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients. The Advisor interfaces directly with UR nurses and medical staff, providing concurrent communication and education regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.


Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. 


Featured Benefits:
      Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
       Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
         Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
         Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
          Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities.

MD Physician Advisor Additional Requirements:

  • Completion of an accredited residency training program
  • Active and unrestricted state Virginia medical license
  • Board certification in specialty required at time of hire
  • Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions 
  • Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments 
  • Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient specific variables as may be necessary or justifiable   
  • Familiarity with (Hospital) organization and case management operations    
  • Excellent customer service and interpersonal skills
  • Able to effectively present information, both formal and informal
  • Superb written and verbal communications skills
  • Ability to set and manage priorities
  • Demonstrate flexibility, teamwork, and a collaborative leadership style
  • Strong technical/computer

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