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Utilization Review Rn Jobs in Virginia (NOW HIRING)

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

Registered Nurse (required) Experience * 3 years of acute care clinical experience (required) * Previous Utilization Review experience (preferred) * Milliman experience (preferred) * Knowledge of ...

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

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 ...

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 ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Virginia

Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Sep 3, 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.

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.

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.

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 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 get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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:

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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 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, with an average salary of $87,192 per year, or $41.9 per hour.

Utilization Review Registered Nurse

3M HEALTHCARE

Richmond, VA • On-site

$90 - $120/hr

Other

Posted 2 days ago

New

Job description

Job Overview

The Utilization Review RN is responsible for utilization management and review for prospective, concurrent, or retrospective cases. The role functions within a multidisciplinary team including physicians, social workers, discharge planning assistants, and payers, evaluating medical appropriateness of inpatient and outpatient services per guidelines and benefit determination.

Responsibilities
  • Conduct prospective, concurrent, and retrospective utilization reviews for inpatient services, observation services, and specific outpatient service requests.
  • Determine medical appropriateness of inpatient and outpatient services by evaluating medical guidelines and benefit determinations.
  • Collaborate with attending and consulting physicians to facilitate efficient transitions during hospitalization.
  • Work with the multidisciplinary team to coordinate care and ensure reimbursement aligns with payer contracts and efficient resource use.
  • Use medical necessity criteria to assess level and setting of care, assist in denial and appeals, evaluate quality, and identify potential risk management issues.
  • Participate in all patient safety initiatives relevant to the position.
  • Maintain professional rapport with providers, patients/families, and internal customers.
  • Train and educate new UM staff nurses and new RN Care Coordinators on job competency and technical instruction.
  • Advocate for appropriate placement of patients to secure correct remuneration.
  • Utilize clinical application systems, utilization review systems, and business support applications.
Qualifications
  • Licensed Registered Nurse in the State of Virginia (or eligible).
  • Current RN licensure in Virginia.
  • Minimum of three (3) years of nursing experience in an acute care setting.
  • Completion of 15 continuing education units per year.
  • Proficiency in Milliman Care Guidelines (MCG) or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
Preferred Experience and Credentials
  • One (1) year of Care Coordination experience.
  • Clinical experience with specialty patient populations.
  • Two (2) to Four (4) years of recent experience in Utilization Review or Utilization Management at a health plan or managed care organization (HMO/TPA/IPA/etc.).
  • Master’s Degree in Nursing or a healthcare-related field from an accredited program.
  • Case Management Certification.
Additional Position Requirements
  • Ability to flex the schedule as needed to meet department demands.
  • Physical lifting capacity of 20-50 lbs.; prolonged sitting; repetitive motion.
  • Strong recall, reasoning, problem solving, hearing, speaking, writing, reading, logical thinking.
  • Ability to handle multiple priorities, frequent customer interactions, and adapt to frequent change.
EEO Statement

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.

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