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Utilization Review Manager Jobs in Virginia (NOW HIRING)

Carillion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager

Roanoke, VA

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carillion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Dane Street

Board-Certified Pulmonologist

Richmond, VA · On-site

$296K - $395K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street

Board-Certified Pulmonology

Chesterfield, VA · On-site

$305K - $406K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street, LLC

Board-Certified Pulmonology

Chesterfield, VA · On-site

$285K - $380K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carillion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Carilion Clinic

RN Case Manager - Weekends

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ... Manages changes to the plan as necessary. * Maintains effective communications with all disciplines ...

Dane Street, LLC

Board-Certified Pulmonologist

Richmond, VA · On-site

$296K - $395K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

Dane Street

Board-Certified Pulmonology

Richmond, VA · On-site

$296K - $395K/yr

Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams

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Showing results 41-60

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:
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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.

Clinical Appeals Manager: Lead Denials & Utilization

3000 Montefiore Medical Center

Norfolk, VA

Full-time

Posted 5 days ago

Job description

Montefiore Medical Center in Yonkers, NY seeks an RN/PA/HIM professional to directly manage the appeals process within Utilization Management. You will respond to third-party denials, interface with health plans, and advise on denial trends. You will analyze Wakefield Division denials, document outcomes in our automated system, and perform first-level reviews for Medicare admissions. Collaboration with Case Managers and CTCCs is essential to ensure compliance and minimize financial impact. #J-18808-Ljbffr

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