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Utilization Review Np Jobs in Virginia (NOW HIRING)

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

$26 - $35/hr

... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ... LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

LMHC, LPC, LMSW, LCSW, or RN preferred. Physical Requirements: Must be able to mentally handle ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

$60 - $80/hr

Utilization Specialist page is loaded## Utilization Specialistlocations: The Pavilion at ... review organization, when necessary. · Graduation from an approved/accredited school of nursing or ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

Utilization Specialist | The Pavilion at Williamsburg Place | Williamsburg, Virginia About the Job ... review organization, when necessary. • Graduation from an approved/accredited school of nursing ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Education/Requirements: • Graduation from an approved/accredited school of nursing or a Bachelor ...

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Utilization Review Np information

What does a utilization review nurse practitioner do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

What are some common challenges utilization review nurse practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

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

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

What is the difference between Utilization Review Np vs Utilization Review Nurse?

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

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

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

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

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

What cities in Virginia are hiring for Utilization Review Np jobs?

Cities in Virginia with the most Utilization Review Np job openings:

Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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