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Utilization Review Rn Jobs in Virginia (NOW HIRING)

UHS

Utilization Review Coordinator

Portsmouth, VA · On-site

Requires minimum four years' experience in nursing, rehabilitative services, mental health counseling, or admissions. Prefers minimum two years of Utilization Review/Management, Quality Assurance or ...

UHS

Utilization Review Coordinator

Portsmouth, VA · On-site

Requires minimum four years' experience in nursing, rehabilitative services, mental health counseling, or admissions. Prefers minimum two years of Utilization Review/Management, Quality Assurance or ...

Lifepoint Health

RN Case Manager

Danville, VA · On-site

Our collaborative approach to safe, effective discharge planning includes close coordination between a Utilization Review RN, Case Manager RN, and Social Worker-ensuring each patient receives ...

Lifepoint Health

RN Case Manager

Danville, VA · On-site

Our collaborative approach to safe, effective discharge planning includes close coordination between a Utilization Review RN, Case Manager RN, and Social Worker-ensuring each patient receives ...

LifePoint Health

RN Case Manager

Danville, VA · On-site

Our collaborative approach to safe, effective discharge planning includes close coordination between a Utilization Review RN, Case Manager RN, and Social Worker--ensuring each patient receives ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... or RN or current clinical professional license or certification, as required, within the state ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R159657 RN Case Manager (Open) How You'll Help Transform Healthcare: Monday - Friday, 8am-4:30pm ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

Carilion Clinic

RN Case Manager

Roanoke, VA · On-site

R151592 RN Case Manager (Open) How You'll Help Transform Healthcare: Full time : Monday - Friday ... Collaborates with Utilization Review Nurse. * Maintains regular contact with assigned Utilization ...

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Utilization Review Rn information

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$41

$68

How much do utilization review rn jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for utilization review rn 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.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Virginia? The most popular types of Utilization Review Rn jobs in Virginia are:
What are popular job titles related to Utilization Review Rn jobs in Virginia? For Utilization Review Rn jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Virginia look for? The top searched job categories for Utilization Review Rn jobs in Virginia are:
What cities in Virginia are hiring for Utilization Review Rn jobs? Cities in Virginia with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in VA? For Utilization Review Rn jobs in VA, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Virginia as of June 2026, with employment types broken down into 1% As Needed, 61% Full Time, 3% Part Time, 1% Temporary, 33% Contract, and 1% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.
RN Utilization Review

RN Utilization Review

Chesapeake Regional Medical Center

Chesapeake, VA • On-site

Other

Posted 13 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

Position Summary
The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria and applies principles of utilization and quality management, and the management of clinical/financial resources as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical information documented from providers ensuring clinical data is substantial enough to meet medical necessity criteria and will facilitate the appropriate billing status.
Duties and Responsibilities
The duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
General Responsibilities
  • Demonstrates the knowledge base and essential psychomotor skills required to effectively carry out the job.
  • Demonstrates the ability to interpret, analyze, and apply relevant data to prioritize and determine a course of action appropriate to meet the patients’ clinical needs.
  • Demonstrates effective communication and collaboration with culturally and professional interpersonal skills.
  • Demonstrates effective time management and the initiative to carry out job responsibilities in a timely manner.
  • Effectively assess, plans, implements and evaluates strategies that ensure the appropriate utilization of clinical resources and management of length of stay.
  • Meets all organizational requirements. Demonstrates initiative to establish and achieve personal and professional goals.
  • Demonstrates effective customer service behaviors as defined by the organization’s mission, vision and values.
  • Attend required hospital-wide orientations, meetings, and in-services.
  • Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care.
Utilization Review / Clinical Responsibilities
  • Using approved criteria, conduct admission and concurrent chart reviews for Medicare, Medicaid, and managed care payers within appropriate time frame to ensure appropriateness of level of care.
  • Refers cases failing inpatient medical necessity screening to physician advisor for level of care determination when indicated.
  • Monitor length of stay and other ancillary resource use on an ongoing basis. Identify opportunities for process improvement and recommend actions. Monitor and document on an ongoing basis avoidable days.
  • Communicates following the chain of command regarding proper utilization of resources, physician concerns, and length of stay activities.
  • Coordinate with the department in-house liaison to assure third party certifications when required. Provide information as required regarding denials/approvals. Expedite the peer-to-peer process through collaboration with physicians and insurance companies.
  • Communicate denials, verbally and in writing, to patients, family, and physician as needed.
  • Interacts with patients and families to educate about level of care when necessary or indicated.
  • Delivers observation notices and notices of non-coverage as appropriate to beneficiaries.
  • Works with the interdisciplinary team to communicate level of care determinations.
  • On a concurrent basis, enter all pertinent data (UR and other areas as assigned) in data collection systems as per policy and established processes.
  • Participates in clinical performance improvement activities as needed and as assigned.
  • Works within the CMSA standards of practice.
  • Ensures compliance with CMS, State, and other regulatory agencies.
  • Liaison between attending physician and physician advisor for level of care recommendations, order changes, etc.
  • Assess for appropriate unit of care delivery within the hospital and make recommendations to the treating physician.
  • Works with Revenue Integrity, HIM, and other internal departments to ensure billing status is correct.
  • Employee must be proficient in his/her job responsibilities at the end of 90 days.
Reporting Relationships
  • Reports to: Director of Care Management
  • Supervises: None
  • 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
  • Minimum Required Education: RN degree required
  • Preferred Education: BSN preferred
Experience
  • Greater than 3 years clinical nursing experience required.
  • Utilization management experience preferred.
  • Must be self-directed and possess critical thinking and excellent organizational skills.

Certificates, Licenses, Registrations
CM certification strongly desirable. CCM or ACM or any approved certification body required within 2 years of eligibility for the exam
Physical Demands and 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.
A separate sheet documenting the description of physical demands and working conditions must be included and attached as the last page of the finalized job description.
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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