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Utilization Review Nurse 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

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 ...

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 ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

Carilion Clinic

RN Case Manager - Weekdays

Roanoke, VA · On-site

Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization Review Nurse throughout the day. * Uses InterQual software to support accurate patient statuses ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Virginia

Utilization Review Nurse information

See Virginia salary details

$21

$41

$68

How much do utilization review nurse jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review nurse in Virginia is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

What does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

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

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

More about Utilization Review Nurse jobs

What are the most commonly searched types of Utilization Review Nurse jobs in Virginia?

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

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

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

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

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

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For Utilization Review Nurse jobs in VA, the most frequently searched job titles are:

Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Virginia as of August 2026, with employment types broken down into 76% Full Time, 18% Part Time, and 6% Contract. Highlights an 88% In-person, and 12% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

499th 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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